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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
Building Permit Application DEC 0 6 2017
Planning and Development Services I - T I f G
Building and Code Regulation Division s'. Lucie
7 L�17 41, FL
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
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Address: b 6 A). 91 LV_ay
Legal Descripticim. ury, L,i A n1l) h- a i �-h an e- d /- 36
Property Tax ID #: 1�71 - 5-M 1073 - 60 6 Lot No. 3
Site Plan Name: Block No.
Project Name: (eq
Setbacks Front Back: Right Side: Left Side:
DETAILED E CRI, TIOW F d
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1 A T 10W" "CONSTRUCTIOU'INFORMA, 7
Additional work to be nertormed under MIS permit- cr
IIHVAC 0 Gas Tank Flas Piping
11 Electric 0 Plumbing []Sprinklers
Total Sq. Ft of Construction: —4-t
Cost of Construction: $ —4ko!b - ob
Shutters LD Windows/Doors
Generator � Roof, Roof pitch
SFt of First Floor:
Utilities: Sewer 0 Septic
Building Height:
1-11". 'V
sCORlTRACTOR S
- - - - - - -
Name -I L
Name:
Company: f::�Mkr_6
Address:
City:
State: -EL—
Address: W a K Dc1 Il) 'e__
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City: Sol" State:
Zip Code:41/9,';_-7
Fax:
_
Phone No. Usy --
Phone
Fax: 9 -6
E-Mail: r- 16- nAa P �" C(�Q��Q
36
Fill in fee simple Title Holder on nakt
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page if different
Phone No.
E-Mail:--,S
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State or County License:
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from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of commencement is requirea.
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SUPPLEMENTAL CONSTRUCTION L77 IEN LAW�I'NFORM�4TION
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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:
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 re orded and posted on the jobsite
before the first inspection. If you4ntend to obtain financing, consult wlendeh or an attorney before
STATE OF FLORIna STATE OF FLORIDA
COUNTY OF OA 7 /a� COUNTY OF F
The forgoing instrument a acknowledged before me
this36day of 20 /Zby
, I/&r lick— �.L
Name of person
The forgoing instrument was acknowledged before me
this.Akday of 20 / 1-7 by
(Name of person acknowledging)
( 'gnature of Notary Public- State of Florida) (Si nature of Notary Public- State of Florida )
Personally Known / OR Produced Identification Personally Known FOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 3,01 (Seal) Commission No. 'lac ,Ay,,'Seal) JUUANNECOLELLO
JULIANNE COLELLO MY COMMISSION # FF 13671
My COMMISS1ON f FF 136715 21, 2018
EXPIRES:Ju 212018 9rPOFF1Aa�O BMWThru8udgelNetAry6avI0
Revised 07/15/2014 EXPIRES:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS