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All APPLICABLE INFO MUST BE COMF.� -_D FOR APPLICATION TO BE ACCEPTED r
Date: Permit Number: R103.0Q l9
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: s a-M and 13 c:.,cb a.eG; �
PROPOSED IMPROVEMENT LOCATION:
dui s Iiti9 N :,kn C
Property Tax ID #:
Site Plan Name: _
Project Name: _
DETAILED DESCRIPTION OF WORK:
I(a—c00-7
11053 L) i iLAO
wawov-�J I DCC"r
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
P4/ // Qvrn--,
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Lot No.
Block No. J k
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Additional work to be performed under this permit— check all that apply: //
_Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors _ Pond
_ Electric Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: Z179 3 _S*
Cost of Construction: $ /—'/'D Utilities: Sewer —Septic Building Height:
Uti/NERf LESSEE:
CONTRACTOR:
Name
Name:22.G o �-`� M Ai 0 A
` l
Address: 1`1 `-1 �, N �����c�`lVC 15 Yt cc,\�
Company: G(Lc6 h:10 Pr :Ypc.,
City: ? M Stater1
Address: S'?05_ NW e-st -Pt; RM CT -
Zip Code: 3 q9 1C) Fax:
City: fok:�r State: I
Phone No. 90 1 330 -1'I LV155
Zip Code: 3`I Fax:
E-Mai1: Ss$ 1�� 0 4�A\A!50ry0c; n
Phone No 17) 4Dl --&%S' 3
Fill in fee simple Title Holder on next page (if different
E-Mail !; M A i DA l 34'- A 0Awo . C OMB
from.the Owner listed above)
State or County Licens
71
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IT vame or construction is LSUU or more, a RECURDED Notice of Commencement is require .
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. z M,)
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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
is in Home
which conflict with any applicable 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorneybefore commencingwork or recordingour Notice of Commencement.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFOR'MATION':
DESIGNER/ENGINEER: Not Applicable
Name: �grti E��u.G l(
MORTGAGE COMPANY:
Name:
Not Applicable
Address: 1C, S'O4-�
Address:
City: .�ectJu►-lL S State: L-
City:
State:
Zip: _ '3��iS (o Phone_��Z � ZZ3 � 1-15 S�
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Signature of Owner/ Less a/Contractor as Agent for Owner
Signature of Co ractor/License Holder
STATE OF FLORID
STATE OF FLOR
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COUNTY OF ..
COUNTY OF • Lll�