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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `Q, Permit Number:
RECEIVE®
Building Permit Application DEC 2 2018
Planning and Development Services ST. LUbe P-9, r, pgrmltt)ng
Building and Code Regulation Division �-
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
�\e end �a`� � d'Y1
Address: 3a.'Z5 MwrR delve- , ti''o6'f P;,e'`rc C � F/_ 3d,
411 9
Legal Description: Silver I -a )�e Pail Il A d o I� LPG Q S 7^ 5 AN
AC gat
OSI SE)t()p
Property Tax ID #: 4do r Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Aaai`tionai worK to oe pertormea unaer tnis permit— cnecK an tnat apply:
/ Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors'
Electric Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: 4 i 3 30 Sq. Ft. of First Floor:
Cost of Construction: $ C5+ Utilities: —Sewer —Septic Building Height:
OWN'ERjLE�SS� : _
CQNTRACTOR:
Name v)A- 0%))
Name:
Address: 3 a, d M %A VOL dr.
Compariy
City: Fo-f+ P l e rc, >a State: F•
Zip Code: 34-9 9 oL Fax:
Phone No. 7 "7 — O —9 3-7 oq,
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
E-Mail: Y1 C 1M a co
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S .B.22 M M% AL MEMO
CTIO LI �N W I
��R. AT 0
DESIGNER/ENGINEER:
Name:
Address:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made,to obtain a permit to-do the work and installation as indicated.
I certify.that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a.full concurrency review; room additions,
accessory structures, swimming pools, fences, walls, signs, 'screen room's•and accessory use's to another rion-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordin your Notice of Commencement.
Signature of Owner/ Le see/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledged before me
this S,� day of D'e C 20 1 by
this day of 20_ by
�n0'\,r\ov4 iYX�k
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi ion
CfL
Type of Identification
Produced 1)
Produced
(Signature of Nota ublic'Fitt,�•;_, ori NpMARIEGNENS
Signature of Notary Public- State of Florida )
IMY COMMISSION # GG 022023
Commission No.�r�daa, • = gp(@ S.. December 16,202o
.'•,,+F
No. (Seal)
••L B(ndedNotaryPublleUnderw191mmission
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
i
DATE
COMPLETED
Rev. 8/2/17