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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: G I?Z Permit Number: /
�1(0
RECIEVED
OCT 12 2017
Building Permit Application
Planning and Development Services Permitting Dept. St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: %m oo-ea n lr) Ue L, n_" �05
Legal Description: �Yf'959 0(>>i�i(���>7 A JI I / ( .i.J�"l r`�l <AJ�
Property Tax ID #: t' L - (n '-U - (JU 1'f" LLIJ ^ r) Lot No.
Site Plan Name: Em nyl , Wrdo Block No.
Project Name:l(y
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCR'IPTION,OF'WORK
e'er ovc-and ► c-P1 aC e C-) N o n - I rrl �C-1- . S1 I oI I:
&�CLSS deCrS aR0J(2)N0Y1-t fflPM - vv► RC10 w S o WS)erner
e-x nG Eha4W,( .
CONSTRUCTION INFORMAT N:
Additional work to e nertormed under this permit— c ec a apply:
❑HVAC Gas Tank []Gas Piping _ Shutters Windows/Doors
❑ Electric ❑ Plumbing L] Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ I0.(2M
OO
S Ft. of First Floor:
Utilities.
Sewer ❑Septic
Building Height:
.-OWNER/LE;SSEE:
CONTRACTO.R *
Name _
Name:%l)1C� P�Cin�
e
Address: c - ' �� -. nI.
Company:-Th'P C-.l(a4g-
'lion
City:.�P�S ; -� f"l . = °_''�', L State:
Address ,3�J-1C ".,
1X `e - tl W u
Zip!Code:3,(L45-J:'",:m .. Fax: " c i
City::. fiL� i% � `:,:
;. { - State: �L
Phone No,L _,_;,J.7a�.,
Phone No. -i?a; AL
0'+E')[I
E-Mail: _ hP.r�PY(`%�'i"
Fill in fee simple Ti It a Holder on next page ( if different
E-mail: ne�f�1S a Cb LC1�Q�Y
(��ta�C�r('Sl(a.
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 CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: i S i State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: `""'r"' 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 OWNERrc
r failure to Record a Notice of Commencement may result in your paying twice for
improvements to your6rty. A Notice of Commencement must be recorded posted on the jobsite
before the first inspectf o obtain financing, consult with lender r orney before
commenckrg-vvark or rIli 'vour Notice Commencement. - '
s
Signatur of e C tr t r as Agent for Owner Signature of Co)htractor7tiGense±ljb1dejr
STATE OF COUNTY OF FLORIDAFLORIDA
�l� COUNTYTY OF .
The forgoing instrument was acknowledged before me
this 2-2- day of 20 ]:!by
Name of person acknowledging)
k )
(Signature of Not Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
KELLY WIDMAN
The forgoing instrument was acknowledged before me
this 'z day of ; 20 1-7 by
e . I,Trc�
(Name of person acknowledging)
2-00 b
(Signature of Nol@Y.P7OR
tate of Florida )
Personally Known Produced Identification
Type of Identification Produced
Commission No.
KELLY WIDMAN
' « 1W •= Commission # FF 929255 ": • Commission # FF 929255
Revised 07/15/2^r,",",o; My Comm. Expires Oct 20, 2019 �a;,,� oP•�:� My Comm. Expires Oct 20, 2019
� list Bonded throw h National NotarV Assn. °''�° �� Bonded through National Notary Assn
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