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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: l_1 R " 0l 0)
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Building Permit Application NUY � 7 2017
Planning and Development Services
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Buildingand Code Regulation Division St. Lucie County,
2300 Virginia Avenue, Fort Pierce FL 34982 FL
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: i b'Anb S ("G2 Pw-% Z>r 36 GI
Legal Description: Ar- 7 CA n 4_1 ` __ QlL .4e Eg ut) 36 .A-
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Property Tax ID #: ��� 1 —( �Oa� s O� - (� Lot No.
Site Plan'Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itiona wor to e e orme un er t is permit — c ec a app y:
�HVAC � Gas Tank Gas Piping Shutters Windows/Doors
Electric 0 Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
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Cost of Construction: $ (2�'�0� Utilities: _ Sewer Building Height:
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Name: ---Tu.5,-r1 ` 1-k 1"q
Address: 10PL U 5 6t;,wN b r 3011
Company: iSIo,n4�) i-
Address: 10$7S S 06e4zn ;D�-
City: '3en �,s,!n, State:_
Zip Code: :;Lt JS- 7 Fax:
City: aCn si <n Rasa i Stater
Phone No.
Zip Code: 3Li Ci Sr) Fax:
E-Mail:
Phone No. I-) a - a 3, 7 - _73 Y 19'
Fill in fee simple Title Holder on next page ( if different
E-Mail: % I e.r y i I<lz f) (smc : I . Conn
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPP�LEMENTALCONSTRUCTlON LIEN LAWaINFtJRMATION °g
DESIGNER/ENGINEER: x 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 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
commen_rJng wo or recordi Notice of Commencement.
Sgnatu ', /Lessee%„ ,tra torasAg jjl _ i`nm
S' natur of o tra or/License Holder
STATE OF F ORIDA
T E OF FL RIDA
COUNTY OF St. Lucie
OUNTY-OF SL Lucie
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this —1 day of NWerv^ k,4 20� by
this "1 day of �r,���Gr , 20 by
^A+-,(5a 1 ' C
Justin Thiery
Name of pe son making statement
Name of person making statement
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary - tate of Florida)
(Signature of Notary Public- State rida )
Commission No. , �aa"i0 d
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Commission No. aStig0N3a8pn81Uiapsp4eq*���,��
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
-REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17