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All APPLICABLE INFO MUST BE COM' - ED FOR APPLICATION TO BE ACCEPTED O
Date:
1
Permit Number:
s.
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Address:
`\eke
Building Permit Application
Commercial Residential
Property Tax 1D #: \`\ '101 - O1A 1— OOo-b .
Site Plan Name: 6
Additional work to be performed under this permit- check all that apply:
_,Mechanical Tank _Gas Piping — Shutters
Shutters
yElectric _ Plumbing — Sprinklers _ Generator
Total Sq. Ft of Construction: �] i"!. Sq. Ft. of First Floor:
Cost of Construction:
Utilities: Sewer Septic
$ � � � or� — —
Name �) inC4 ►�Cnzi\�
Address: \'�:)\ (3
City: \N4-,k L 06n!�Q-% State: \-
zip Code:`� y Fax;.
Phone No.
E-Mail: JY�CN�T�J-���I:TOe2 '�� rl. cone
Fi11 in fee sirnpie Title Holder on next page ( if different
from the owner listed above)
�ti 4y `i
Lot No. ' {�
Block No. 15
Windows/Doors
Roof Pitch
Building Height:
Name: A i IvV V a r
Company: i
Address:
r State: s
City:
Zip Code: p` Fax:,
Y ,
Phone I o :.
E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
C 7
MORTGAGE COMPANY: — Not Applica ble
DESIGNER/ENGINEER: — 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:
Ad d ress:
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
Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which is in conflict with any applicable Home
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 Courity 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 IIMPROVEiME14TS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT (MUST BE RECORIDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
PITH YOUR. LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Contractor/Licens riolder
tore-Gf Owner/ Lessee/Contractor as Agent for Owner
STATE OF FiD�
STATE OF FhniD,n
COUNTY OF 4 ��
COUNTY OF0 f,
Th foSLrg instru nt gras cknowledg9Abefore me
i instrument was acknowled before me
Th oRp
�/12
t day of (/� 20_�by
thisy of
`by
O
�
Nameson making statement.
Nam person ma -kink statement.
Personally Known Produced Identification
Personally Known OR Produced Identification
Type of Identificatio
Type of Identificat on
Produced
Produced
(Si -ure p-lgotary Publ' - State of Florida)
i ure f N ary Public- State of Florida }
Commi (Seal)
Commi n No. (Seal)
"I Notary Public State of Florida
DanyelJon s
D nyel Jones
REVIE Q°FR�', s is ryGG, �16 UPERVISOR
/2� +I�
PLANS I V �� � E '.r $ -QI -Qa 2 1MA ROVE
l�'t RE- I'EW
REVIEW
REVIEW I VI�IN`
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19