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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n n Q
Date: Permit Number: �hJ4-
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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 Residential
PERMIT TYPE:
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Address: 2 ( Zd b G-C(e�5
Property Tax ID#: o0191 (9L Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank ,Gas Piping _Shutters —Windows/Doors,
✓/Electric _Plumbing _Sprinklers —Generator _Roof: Pitch
Total Sq. Ft of Construction: Sq..Ft. of First Floor:
Cost of Construction: $'C K�,D�� Utilities: —Sewer _Septic Building Height:
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1 Name 5LD-C2P P, e Name:
Address4400 a- 3w NO vLe S� I Corn pant':,
City: RAS� Lac-cc State: p Ad res'" S
Zip Code: 3 99 53 Fax: city _n h i e t State:
Phone No.
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E-Mail: .%osSeC�e.(g,-8o -4 (w 1�i��c�.Con- >PIYOf12x10-
Fill in fee simple Title Holder on next page( if different E=lVlarl
from the Owner listed above) I State or County License
If value of construction is$2500 or more,a RECORDED Notice of Commencement is;requrredi
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required `
i�
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:
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
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 NONCE OF COMMENCEMENT ,MAY RESULT, IN YOUR PAYING
TWICE FOR IMPROY;EMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT (MUST BE RECORDED AND
POSTED ON THE .JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Sign er essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STAZEOF FLORI STATE OF FLORIDA
COUNTY OF �.,,� COUNTY OF
The forgoing inst ment,.vas acknowledged before me The forgoing instrument was acknowledged before me
thiday of 2 by this_day of 20_ by
Na e of p son making statem t. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific ion Type of Identification
Produced,— Produced
(Snatu e o o (Signature of Notary Public-State of Florida )
s�ellr#rvun o�
Commission No. #!( gl i, =`• Commission No. (Seal)
REVIEWS F ` I' '� , R PLANS ' VEGETATION SEA TURTLE MANGROVE
REVIEW I REVIEW REVIEW REVIEW
DATE
RECEIVED
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