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All APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! �Permit Number:
I
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:
Residential l/
Address: 6 c RF-t "I c) ,V i i TT Vi e
Property Tax ID #: / a — ' O '6OJ — Lot No.
Site Plan Name: 1 UJ e-en Block No.
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Project Name: en
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Name Z) V �'e
Name:
Address: /
Company:-
City:�`�� 'L(TC -� State:
.Address:
",City: State:
�+^I
Zip Code 9J l Fax:
Phone No. R ��%
Zip Code: Fax:
Phone No
E-Mail 4eav) m P �" k�
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 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.
DESIGNER/ENGINEER:
Name: 60AJ� 4 A:2
Address: / JO III S�
city:/1/6 ao
0
Zip: � ne
FEE SIMPLE T�TLE HOLDEI
Name: JO � S
Address:
Zip: Phone:
Not Applicable
State
70 _
r Not Applicable
MORTGAGE COMPANY:
Name:
Address:'
City:
Zip: Phone:.
BONDING COMPANY:
Name:
Address:
rihp
— 5;?2-g -Od jb; Zip: Phone:
t Applicable
State:
Applicable
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
swhich is in tructure. Please consult w with applicable
Owners Association Association
reviewyyour deed or any re trict o s nts that wh chtrict or may a. prohibit 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 JOB SITE BEFORE TIME FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH WUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Si nature o 0 er/ Lessee/Co ,actor as Agent for Owner Signature of Contractor/License Holder
I
STATE OF FLORIDA G STATE OF FLORIDA
COUNTY OF �� 1 /� COUNTY OF
The ,—ff ing instru e t was <nowledge�J Ty,
re me
thisday of Z- 20_
None of person making state
The forgoing instrument was acknowledged before me
this day of , 20_ by
Name of person making statement.
i
Personally Known R Produced Identification Personally Known
Type of Identification Type of Identification
Produced 17 V Produced
OR Produced Identification
(Signature of Notary Public- State Signature of Notary Public- State of Florida )
SANDRAROTKISKF. 'k (Seal)
Commission No.&(' 01.�` tro < )Notary Public State of FCOTmission No.
Commission N GG 21 567
REVIEWS FRNT ZONINGI COUONTER I REVIEW S REVIEW REVI W UPE "PLANS I VEGETATION EVIEWS REVIEW LE
RvTscTRT
RECEIVED
DATE
COMPLETED
MANGROVE
REVIEW