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FALLPLICABLE 1 FO MU T BE COMPLETED FOR APPLICATION TO BE ACCEWa)
Date: 1�':'10 J I" Permit Number:
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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 APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: �( � �'Yte, y (, - P P/
Legal Description: UM c6 kargi QrGt N ila 1& 22
ma ,327-7- 1 D
Property Tax ID#: �'�"� 0 v Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D'ESCRIPTIO'N`OF WORK:
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CONSTRUCTION INFORMATION:
Additional workto e partormed un er t is permit—check all apply: Il
0HVAC 0 Gas Tank ❑Gas Piping _Shutters. Windows/Doors
0 Electric 0 Plumbing Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. f First Floor:
Cost of Construction:$ F (D5 Utilities: &Sewer _Septic Building Height:'10 � 7
OWNER/LESSEE: . - . CONTRACTOR'
Name �C� Qf?11 �' 12d'h Name: am-e-5 -a}'
Address: i00_LM9i 04' Company: W (1- �2116he're-
City: l t C'� Stater Address: PO x
Zip Code: Fax: City:afar C e State:TL
Phone N Q,_�1 - Zip Code:g2clfrl/ Fax: 952 410k111-
E-Mail: L_-)n_nQo'_ C_b ,hone No.,52 �/OS /l/
Fill in fee simple Titl Ider on next page t if different E-Mail: . 10 TYi�-�e P( �/.l yYt (,owe.
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement isirequired.
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SUPPLEMENTACONSTRUCTION LIEN LRUUINI�QRMATION• NP
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: j _Not Applicable
Name: Name:
Address:IdD D Address:
City�0�dnd Statef=L City: State:
Zip:32'r20 Phone: _3R q g �40(4 Zip: ,Phone: !
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: I.
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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. 1
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 work or recording our Notice of Commencement.
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Signature 0 ner/Lessee/Con ractor as Agent for Owner Sign ur of Contractor/License Hol Y r
STA STATE OF FLORIDA -wp OF FLORI),qPA�
COUNTY OF C �Uy� COUNTY OF W FDrL>>
The for in instrumen was acknowledged before me The forgoing instrument was acknowledged before me
this y of 20 by this 13 day of 10 20 LL by
(Name person VCknledging), (Name of person ackri wledging)
(Si natur of Public-S , to of FIbrida) (Signature of Notary Public-State of Florida)
Personally Known OR Produc Identific tion �� Personally Known ✓ OR Produced Identification
Type of Identification Produced L D Type of Identification)Produced
I
Commission No. (Seal) Commission No.
V PVBy� C S UNDERHILL
Notary Public State of Florida• Public-State of Florida
MAYNARD My Comm.Expires Oct 12.
Revised 017/15/2 4 MY COMMISSION#FF113673 ! �';F r��, Commission# FF 132509
EXPIRES:April 16,2018 am.OFF�ua I
Bonded throw h Western Surety 1
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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