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i` ALL APPLICABLE INFO MUST BE COMaLETED FOR APPLICATION TO BE ACCEPTED
,
Date. S Permit Number:
Building Permit Application
RECEIVE
AUG 3 1 2015
Planning and Development Services
Building and Code Regulation Division
2300;Virginia Avenue,. Fort Pierce FL 34982 _
Phone: (772) 462-1553 Fax: (772) 462-1578 CoMmerc al —..v. Residential
PERMIT APPLICATION FOR:
PROPOSED I;MP:ROVEMENT LOCATION:`
Address: � 7 1 .. �/�U%JJ lYff.�3�✓l ��i�'I� 7
Legal Description: Wjjgl-)M i u..1ft I I A-6 --m ' 5 EA CodJowleizc-tM 4(0.t do I % 4-1
n-ti a p:R,D -, a 'i n ,-5 4a!g . i K-) rp rn ,m 0 Lr. LC- vYI Eh)M ( Q-9- 3710 - -2-1 Q 3>
Property Tax ID #: 4S(1 - 49(0- C 049 - Q(2y-(,0 Lot No. �
Site Plan Name:
Project Name: _
Setbacks Front Back:
DETAILED DESCRIPTION OF )JVORK:
Right Side: Left Side:,
0, 8AX-2) —/& U CT 1\42 KJ 6i �JAl `- Pik t G., y 1&5 /0 0A CE-
CONSTRUCTION INFORMATION:
Addna workto- e_.pe orme under this permit - check a that apply, : 7e /
VAC _ Gas Tank —Gas Piping _ Shutters V Windows/Doors
/Electric ✓ Plumbing _ Sprinklers Generator ✓ Roof
Total Sq. Ft of Construction V
l`.V Sq. Ft. of First -Floor:
Cost of Construction: $ �!i1end Utilities: ✓ Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 64f- 7 AA?-
Name:' '_
Company:
Addreost SOIQay-arJ b e,. I
City: INFAL A State:9Q
Zip Code: 3 q96:1 Fax: 66/- - 'J�os
Phone No.
E-Mail
Fill in fee simple Title Holder on next page( if differen "'
from the Owner listed above)
Address: 0 5i I
City /1 Stat
Zip Code:? R J �7 Fax.6&/ 4%1--4�)&S
Phone No. 'J-72-- j- CI 4® 5—
E-Mail: 6
State or ounty License: Cam
If value of -construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applica I
MORTGAGE COMPANY: _ Not Applicable
:.
Namer I-kj )�AQ lS I
&kJ1Name:
_1404) (—
.A)fh
Address: 5 uP
Address:
City:
Zip: 3 -c14 Phone: '7'Z'L----21eI—
State: zlN
(ol�,�
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: V Not Applicable
Name:
Name: AAV AJE
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
1 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 th`e 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 with lender or an attorney before
commencing work or recording your Notice of Commencement. _
_ Signature o f'owneo/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF (MC,,
The forg ing instrument was acknowledged before me
this 3 e day of v C 20 I S by
SL4sc, , N (rrco f= 7 car C /V"-e
(Name of person acknowledging)
s
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of
(Name of person acknowledging)
20 by
(Signature of r4otary Public- State of Florida) (Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification / Personally Known QR Produced Identification
Type of Identification Produced on, L(-, Type of Identification Produced
Commission No. w L ALCMERMES Commission No. (Seal)
,•`a r'"►4�, y p . Stub of Flwlda
?� 240343
my Comm. Est Jul 6, 2019
Revised 07/15/2014.: "'''Eor��
.f;,••••' 8NmgmAssn.
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ZONING
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MANGROVE
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