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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��'�`� •1 !J Permit Number: I !I IO
RECEIVED
Building Permit Application OCT 2 3 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 5t. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
'PROPOSED 'IMPROVEMENT LQ``CATION; C.
Address: �o� u r c_k1wv1 1Z1 vQ . f % �1 tet�G t° �� 3y / o Z
Legal Description:
Property Tax ID #: 3402-608-0427-000/8
Site Plan Name:
Project Name: Hannah Barker
Setbacks Front Back:
Right Side: Left Side:
Lot No. 33
Block No.
DETAILED DESCRIPTION °OF WORK
O LU► Lt nc�.v?
CONSTRUCTION INFORMATION:
Additional work to be nertormed
E1HVAC L_J Gas Tank
under this permit —check all
Gas Piping
apply:
Shutters
a Windows/Doors
11
Electric
0 Plumbing
Sprinklers
Generator
1:1
Roof
Roof pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 2,200
S Ft. of First Floor:
Utilities:i Sewer Septic Building Height:
OWNER/L'ESSEE: _ .
CONTRACTOR:
Name &VU&GeiC
Name: XVW.4A(�
Address: 59-05- NiCf4v14 Dt2ivY"
Company: JZ4 LfeCk(_,l. LSwe_ LAY L(,C
City: f% ai e_d c y, State: Fl
Address: // G/ -) q ih
Zip Code: 34982 Fax:
City: D(�eCUV�c��.�� State: rl
Phone No. 772-539-3025
Zip Code: 3Lfe Fax:
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail: 6a/1/&6I ,
from the Owner listed above)
State or County License: C$G
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
' SUPPLEMENTALCONSTRUCTION,LI'ENfLAW
INFORMATION:
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: L 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
commencine work or recording vour Notice of Commencement. �!~
rl�44a�/
Signature of Owner Lessee/Contractor as Agent for Owner
Signature of ractor/License Holder
STATE OF FLO
STATE OF FLORID 1pCOUNTY
OF ICI U(� 1�
VITAI)
COUNTY OF In 1 a Yl 11l lity
The for oing instrum nt was acknowledged before me
The forgoing instr nt was acknowledged before me
W
his tday of 20� by
this ��- day of 20� by
L
�a.nna h &.r a
- pAbh Yl 1 umm
Name of person making statement
Name of person making statement
✓
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced OL
Produced bL
JAV vp!�r J.A y
LANGFELDER
Signature of Not ri ofd�l9fd W16n # FF 9d0757
(Signature of a gfdtifyl�i6�c • State of Florida
• Commission,• FF 940757
� My Comm. Expires Aug 7, 2019
Commission No. My CoffA?6 iras Aug 7, 2019,
Commission No. '' Rf�t•�`� Bonded thro�MBiltiDnet NotaryAssn.
-'ram-ow Bonded through National Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev.8/2/17