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All APPLICABLE INFO_ MUST _BE COM(._,_ : `) FOR APPLICATION TO BE ACCEPTED
` Date: 5 3d �_ Permit Number: 1� 65 dG as
RECEP.' I MAY 3 0 2017 -
Building Permit Application
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 x Residential
APPLICATIONPERMIT FOR:
'.�zS'.A �.': CC`.� #. —'.� V Je y��R f�'% N �'�#`S ; '�' • „ `.u,, Z#...-�$ '•�' n - k - l�
Address:,-
-z
Legal Description:
Property Tax ID �� �� ' S0 �" i� d 1'' �1dC� Lot No.
Site Plan Name: Block No.
Project Name: JA, Cj &-, ��s �2 i� P r
Setbacks Front_ Back: Right Side: Left Side:
ditional work to be pertormeo unaer tnis permit- cnecK an mat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
TotaC=Sq A' of.'Construction:
Cost of Construe#ion: $
l•r,
T
A/,
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Address: // I- 'sW (_:w+06,Q CT:
Y
. y
City: 1�6z.i c kl�ir t:� V Stater F&
Zip Code: 3, i C! 93 Fax:
Phone No.( 9"S1i'1) o2 5 8 3 S
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Com
Building Height:
Address:
City:cTi2Se� A&0k__i7, State;/C
Zip Coder Fax, �3� �Oloo7
Phone No "7 % - !o 1_e—/V4e4
E-Mai i
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
'r
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ 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:
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 ari-attorney• before
commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Co tractor/License Holder
STATE OF FLORIDA
` 'V3_r
STATE :OF FLORIDA
COUNTY OF ��Z����
COUNTY OF
The forgoing instrument was acknowledged before me
The fo, ing instrument was acknowledged before me
this day of 20� by
this day of 20./ by
ChnsE� n a-
5c.l?��� �
(Name of person acknowledging)
(Name of person acknowledging)
of No lc- State of orida
(Signature ry )
(Signature of Notary P �° a ""
ry .��lbLc -State of F.la[1
Personally Known OR Produced Identification oL
N �n P My Comm. Expires Nov 18; 2018
Personally Known '" uced idl niffitaptigPt77743 as
Type of Identification
IyRe of Identification- .- '` Bonded through National Notary'Assn.
Produced t_ b - IL - U U 'Sq Q. ASHLEYZ
AFR uce 9.
Notary Public -
Commission No. �-,C� h Co d5) ` �w Commission
tate of Florida sn.
��
caftlihissi No. (Seal)
,v�OFF`OPo,, My Comm. Expir
sJun11,2021
Bonded through Nai
onalNotary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
- ; RECE-,1!'7D MAY 3 01017
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CI S,b I� ST. LUCIE COL!�lTy
BUILDING DIVISION . (�
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MUBT ®E KEPT ON JOB 'OR,
NO INISPEC'TI 1p/ WILL E3E �
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