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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �_ 3 • Permit Number:
., ... Yam- .
agCENED
Building Permit Application ApR 3 o loll
Planning and Development Services ppartme
Buildingand Code Regulation Division P�rmitti cl
9 �c. Lucie. Co
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: rn; Q C
Address: 7,D / 11 yam`" J i
Property Tax ID #: 311 — 4201,9 — 00-60 % Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed underthis permit— check all that apply:
Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: p ®0
Cost of Construction: $ �T�D(a Utiliti
Name //.
Address: /d 7-5 % _5' g��1 b /« ,z4_z
City:�P/lse deg a State:
Zip Code��Fax:
Phone No. .�� 6�� d�%90 �.�f% 97/
E-Mail: e-Q1e�r/7 /C Goo
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Generator ' " _ Roof Pitch
Sq. Ft., of First Floor:
es: —Sewer —Septic Building Height:
Name:
Company
address':"'-_
City: 1,'.. State:
Fax:
Phone No
E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is reyun cu.
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 oo ine worK dim III�Ld1101.1U11 a� „u,��«�•
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
structure. Please consult ithpyoiurHome Owners Association sand rules,
ylaws or and your deed or any restrictions nts which may arestrict or l. 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,'N THE JOB SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR -AN ATTORNEY BEFORE RECOWANG YOUR NOTICE OF COMMENCEMENT."
Lessee/Contractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrAnent was acknowledged before me
this day of UJsiDtfzi± 1 20, Iby
C 0-rCNA.
Name of Q20on making statement. /
Personally Known OR Produced Identification
Type of Id nti tion
Produced
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
Produced
(Si ature of No (Signature of Notary Public- State of Florida )
AUDREYB.HUMPHREY Seal
Commission No. 2 OMMISdGG300817 Commission No. )
o EXPIRES: March 6.2023
• �rFoc F���•'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED