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1JHVAC Gas Tank ❑Gas Piping ;�„ � Shutters
11 Electric Plumbing E]Sprinklers ❑ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ g �]�, u
S Ft. of First Floor: _
Utilities:U Sewer Septic
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Fill in fee simple Title Holder on next page ( if different
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from the Owner listed above)
State'or County license:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required
QWindows/Doors
Roof Roof pitch
Building Height:
Fax:
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_ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: - •
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
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 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 vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLRCOUNTY OF O JD wq i STATE OF FLORIDACOUNTY OF T
The forgoing instrumeen.t,, was acknowledged before me The forgoing instrument was acknowledged before me
this � day of ZU11 _ 20 i2by this � day of y , 20 _ by
(Nam of" erson acknowledging)
g) (Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Prod ed4dentification X
Type of Identificati
'"N,MICHAEL ADDEO
Commission No. ,k.�'
="� •'=MY COMMI&91!)1 # GG035806
'•.',;ey,,o,,' EXPIRES October 04, 2020
Revised 07/15/2014
Signature of Notary Public- State of Florida )
Personally Known OR
Type of Identification Prnrh irp
Commission No.
Identification l
MICHAEL. ADDEO
Y COMM* # GG035606
EXPIRES October 04, 2020
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