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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3�a���� Permit Number:MM
RECEI\ �D I;A 2
Building Permit Application
Planning and Development Services
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:
PRQP®SED INPROUE�MEIVT ®CAT LI1,
Address: ' 3 L �'
Legal Description:�,he,(P-)Q0A.Rc�tEkg
Property Tax ID.#: 1"�O'a" a"`' 8d�tJ' CSb '� �S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: (* Right Side: 41.4• Left Side: A
D TAILED D O'N OF WORK:
s
C®NS*TR U'CTI'O INN FO RAM ATI O'N
Additional work to be performed under this permit—check all that apply*
_Mechanical _'Gas Tank _"Gas Piping _Shutters VVindo\ivs/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: - :`.. < Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LE=SSE' : CONTRACTO'R:
Naitie:'` •; .� Name:
Addre'ss:' CQ Company: L@�
City: c State: Address: l
Zip Code: Fax: City: P�,�-D,e�. Stater
Phone Nc/:2� s�L:� — L Zip Coder !i(,, Fax _ 6"Z6 rY
E-Mail: Phone N
Fill in fee simple Title Holder on next page(if different E-Mail CA. "'l
from the Owner listed,above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
I
MPLEMENTACTI'®AOL
IN LIEN LAW INF®RMATION:
,,.
DESIGNER/ENGINEER: * _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: 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 rooms and accessory uses to,another non-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 witr lender or an attorney before
comrrAncing work or recorcling,your Notice of Commencem
SI ature of caner/Lessee/Contractor as Agent for Owner S ure of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF 5k COUNTY OF
The for oing instrument was acknowledg before me The for oing instrument was acknowledged before me
this^ day of Xl%'*, 20� by thisa•� day of V4% 20n by
`1'�ice� �'C�! ��► C�� �'n� �-s, � �� '�'�'��
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publ -State of Florida) (�4ma=ure Notary blic-�Statef Florida)
Personally Known OR Pro Personally Known =IdentificationcationType of Identificatio D gNAtdARIEGIVENS Type of Identificationro' • Produced ' IE GIVENSProduced = MYCOMPdISSION#GGo20?0 N#GG022023EXPIRES:Decemr 16, mber 16,2020
ota Public Undenmlerss+Commission No. BondedTh Commission No. �• blicUnderwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
R—ev—. 7/2014