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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO 8EACCEPTED
Date: Permit Number: / (o D �'
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- Building Permit_ Application JUL 2 9 2016
Planning and Development Services
Building and Code Regulation Division
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
PROPOSED IMPROVEMENT LOCATION
Address: QGG? Z�Y 40L V9 �r2T 5AW7 WC-IFL
Legal Description:
PropertyTaxlD#:`Lot No.
Site Plan Name: 5EEG01-1- Block No.
Project Name: S�C�D7-
Setbacks Front Back: Right Side: Left Side:
DETAILED, -DESCRIPTION "Of
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nC�NSTtUCT10N INFORMATION
y
Aclart�onawortee rme u
HVAC
m-c eca
Gas Piping
app.y._
Shutters
Windows/Doors
sTank
R g
Plumbing
Sprinklers
Generator
L Roof
Electric
Total Sq.-Ft of Construction:
S . Ft. of First Floor:
Cost of Construction: $ I, y05•.� 3 Utilities: [Sewer
❑Septic
Building Height:
O1dUNER/LESSEE^ - - Y
ONl'RACTOR .
Name (Pj_l z> 10
Name: DEAN N 1 SCJc I DE (Z-
Address:_",�' -f" -
Company:ki
City:. State: Ell•
Address: 3a3a SE D))(16 i4L-�Y
Zip Code-0y4 t 0 Fax.. _-
-
City: S`l`u Pw-T State:
Phone. No. . -� - ' __
Zip Code: -7 Fax: 77-3^aH7-
E-Mail: c2. __ _
Phone, No.77a^ 987- �l330
Fill in fee simple Title Holder on next page ( if different
E-Mail;
from the Owner listed above)
State or County License: �� a 3?
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
SUPPLEMENT3AL CONSTRUCTION LIEN LAW INFORMATION:
-.
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 Coun makes no representation that is granting a permit will authorize the permit holder to. build the subject structure
which is in contlict 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 forany 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,bie recorded and posted on the jobsite
before the first inspection. If you intend to, obtain financing, consult with fender or an attorney before
commencing work or recordinr? your Notice of Commencement.
z2-ee-4 S.4A. :-x 61, 2'A"o V) s
_ Signature of Owner/ Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF MA-121-) iJ 1COUNTYOF M 0(I-*l TJ .
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this -�M day of X i U 20 Cle by this a8rlfday of Ju 1`( . 20 1 rO by
PEAw 1 S'CH 1ULfrdaP_ 504N61P`e'r—
(Name of person acknowledging) (Name of person acknowledging )
Z--_� 0--A— �yl� � 6-7
(Signature of Notary Public- State of orida) (Signature of Notary Public- State of Florida
Personally Known �R Produced Identification Personally Known Produced Identification
Type of Identification Produced Type of Identification Produced III fill
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(�MISSION ' • �F`
Commission No.F35�o� �N ��i� Commission No. �FFi3'oT M srp•.
����•�MMISSION� �(�
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Revised 07/15/2014 = ®® ' * = 2 •: a �
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