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All APPLICABLE INFO
/MUST BE COMPETED FOR APPLICATION TO BE ACCEPTED /
Date: C/c`E` `I' ��� Permit Number: ��`O-Cc
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Building Permit Application 20y7
Planning and Development Services St. PER'VLITT[NC:.
Building and Code Regulation Division LucieCounty, FL
2300 Virginia Avenue,Fort Pierce FL 34982
phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
'PERMIT APPLICATION FOR:
�Rt��PC3SED�INP; C3�1/E &Ei �lt���►'CI��� fr _ �� �: ' .� ��� �:4�. ..
Address: 5 ZZK wyk De- ol4 Rrc,L� FL U
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Legal Description. 1�.. ��� 2 �er � �. �.��. - E T� 1
/ , 3 W h N 09— 3113 —13ct
P operty Tax ID#: y�Z f�; (75" Od�3 Lot No.
Site Plan Name: Block No.
Project Name:
SI tbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit-check all that apply:
_Mechanical _Gas Tank —.Gas Piping _Shutters _Windows/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:
tINE; I.ESSE � `. t:{ ONAC1R` r
;Name t✓"-C r Name
Address: Ur Company.
City: State:State: L Address:
Zip Code: Z4"Z- Fax:�� City: Stater
Phone No. i�S-Z8 -2Z77 Zip Code: Fax:
E-Mail: � + �- (a_ C � �^ r& Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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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 l will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes an6 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 j'obsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording ou tice-of Commencement.
nature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SiC,J�,�r�� COUNTY OF .
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this V day of 20/-7 by this day of 20_ by
Name of person makint statement. Name of person making statement.
Personally Known OR Produced Identification ` Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced 'Produced
Jathre of Notary Public-.State Florida). Signature of Notary Public-State of Florida)
�LASHAHNA INGRAM
Commission No.
p(SQa)rublic-State of Florid i mmission No. (Seal)
• MY Comm.Ere FF 177249
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ommission
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Bonded it►ough National Notary A sn.
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REVIEWS FRONT, t VISOR LANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED .
ev. 8/2/17