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AN APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `(1�
Date: (' 0 - Permit Number: 111 NO-
R
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 APPLICATION FOR:
Building Permit Application JUA 12 2017
PER11,61171NG
St. Lucie County, FL
Commercial Residential V
Address: L3 95 (
Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: �c�f2 !�1' Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ional work to be pertormed under
Mechanical _ Gas Tank
s permit - cnecK a
Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
x ..w$ — �
Cost o&Consstructier
a
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
®WN'ER/LESSEE:
C®NTRACI'O'R:
Narr e c
OC6
Name:
Company:
Address: c-` "q—
City: ' '-
Stater
Address:
City: State:
Zip Code: '
1 /Fax:
Phone No
p
Zip Code: Fax:
E-Mail:
/
Phone No
Fill in fee simple Title Holder on n t page ( if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CCiNSTRUCTIpN 1.10 LAW fiNFORMATION:
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:
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
commencing work or recording your Notice of Commencement.
Owner/ Lessee ontractor as Agent for Owner
Signature of Contractor/License Holder
Signat'.`ieof
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ,,; . _, I �.
COUNTY OF
The f9rrgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20�1 by
Mn L�
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
1Yy�� KAREN S. NIEL
v entification
Produced Commission # FF
1 e 'PC
My Commission
Commission No. IF June 12, 2C
Expiroa
1(B0mmi ion No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014