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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Dat o%) Permit Number:
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
PERMIT TYPE:
Address: c7 " v I I ' ►I-iC
Property Tax ID #: 6
Site Plan Name: �J_0 h N
Project Name: <I_1 ' %=
7-47,1111 0
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Residential L'/
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Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tan - _ Gas Piping _ Shutters
"Electric _ umbing _Sprinklers _Generator '
Total Sq. Ft of Construction: 13,00 Sq. Ft. of First Floor: _
Cost of Construction: $ ?) D Utilities: —Sewer —Septic
Lot No._
Block No.
= Windows/Doors
Roof Pitch
Building Height:
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Name --Peyl
:Name: -
Address: LVo 0 L
Compa'ny: '
City: (-1 ( e_1L_L P State:
Zip Code: 3 Fax:
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Phone Now. / 2 , V - 00'f
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail:,Jl��`Q�'lS �j et� vL'V�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 52500 or more, a RECORDED Notice of Commencement is requires.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to ao the wui r% cmu I o.
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
trlucture. Please consult w with yolurHle Home Owners ome Owners Association
son and review bylaws ur deed or any covenants that
wh chtrict ormay apply. obit such
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 .IOU SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR JOENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
S' nature of caner/ Less/Contractor as Agent for Owner
W;T�
STATE OF FLORIDA '
COUNTY OF r6Jwvl 1,!/�
The fo,ng instrulrpent was a < owledge4b�fore me
this day of V� (� by
Name Name of person making statement. /
Personally Known OR Produced Identification V
Type of Identification
Produced
7ofTlGricliT
"' SANDRAROTKISKE
Notary Public - State of Fla
Commission # GG 21a56
(Signature o Notary Public- St e Comm. xpves un
Commission No. GG 21�% (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
-Signature of Notary Public- State of Florida )
Commission No. (Seal)
SUPERVISREVIEWOR I REVIEW PLANS I VIGITATIEVI WON I SEA REVIEW TURTLE
VEWLE MANGROVE
REVIEW