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LALLPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t
Date: Ll11Permit Number:
RECEI`.'rD APR N C 7117
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
'Phone:1772)462-1558 ':Fax:�J772)462-1578 !CO>, m, erciaa =Rtesideitti,a'l
PERMIT APPLICATION FOR: :ne
P �}P{3SED IMPROUEMEt�ITn LQCAT10i�1-�M ,�2 y n �
Address: CZ 14 ai-�R,1 P o a�
Legal Descri�tion: 2 ?J t Z g 6 1 'CSS �� 70 ft ' 03tt amd le5S MaA4- �� w 'l2 4
0� �C 1/2 CY67 W Of e-V-, 1 a'9et t55 C-Z-4 pGjC1�l.�- w1t 2
4F,��_I Sty �'—vp i`��i+ri�-(ram__ (L�a-G�( l� racy h vi �,1 l r r n fs SCc. ?,�. q�r�G
Property Tax ID#: ?iZZL' -I l I - DMZ - ODD -2 Lot No.
Site Plan Name: hG�7 Block No.
Project Name: C�5 dGS pool '/—_>AV3
Setbacks Front Back: Right Side: Left Side:
DETAILED DESGRIP7ION OF 1�UGRK` �� F ,� � � }: Z
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Additional work to be nertormed under this permit-checK aM
apply:
r]HVAC Gas Tank Gas Piping Shutters gWindows/Doors
Electric Plumbing Sprinklers Generator _Roof Roof pitch
Total Sq. Ft of Construction:, 7-716 S . Ft. of First Floor:
'Costa#CorAstcGio :$ q6 lltilities: .SevuerSeptit 8uil:clirg'Height: IS ?J
O1lNER LSSE f a' 4 GOiRACT{ R
Name Name:
Y
�ruYt VGS
�CC G orn an
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Address: (v ddr � p y�
City: State:. Address: 2000 GOL0��1 l�c.T
Zip Code: 4' Fax.: City: DCa _ State:
Phone No. Zip Code:
3432 Fax: 1 �llo I ' �-I 1"70
E-Mail: Phone No. I .
Fill in fee simple Title Bolder on next page( if different E-Mail: aybtCGJ1 rJOCe 1,D rn6 J- (_aw)
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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:
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 with lender or an attorney before
commencing wor or recording our Notice of Commencement.
s
Signature of O er/Le ee/Contr ctor as Agent for Owner Signatur of Contract r/ cense Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF COUNTY OF T LL-c Gt
The for ng instru nt was acknowledged before me The forgoing instrument was acknowledged before me
this�tlay of Y 20�Zby this L day of�j Y 20 17 by
�Q�l ly �C����S •�h� -f 5C��'
(Name of person acknowledging) (Name of person acknowledging)
Aignat.re of No ary Public-State of Florida) ( ignature of Notary,/Public-State of Florida)
Personally Known _OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced
/� Type of Identification Produced
Commission No. (i tit �� mission No. C ��y� �/ (Seal
ON7
IM A NOTORIS M A NOTORISuea; My Comm.Expires May 9,2017 Notary Public-State of FloridaRevised 07/15/2014 My Comm.Expires May 9,20174,X? ; Commission#EE 884154 Commission#EE 884154REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA TURTLE MANGROVE
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