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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
Building Permit Application AID§?
Planning and Development Services
PcRf``rrniN!C
Building and Code Regulation Division
Si. Lucie COU11t1l, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
P'RQPOSED INPRDUEMENON LC1GA Ia,N:
Address: eEA S
Legal Description: �ge ' (/� Gib ��Z3O ,S 2I V 2
Property Tax ID #: 3 70j b ,� 11O2 Ol%71 — Ma 4 Lot No. 2;7 4' 23
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D�-�SCR1'PTtON ®F W®R�K:
d r WO1 f' t�GC/l Gj C� O GI b0
' kea•W ' Dc(f'K4/1 o A -0 .-dole, Slit
CONST UCTt®N INFORMATtiJN:
itiona wor to a per orme un er t is permit—c ec a that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _Windows/Doors
Electric ✓Plumbing _ Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: 6S Sq. Ft. of First Floor:
Cost of Construction: $ dDa Utilities: _Sewer _ Septic Building Height:
OWNER/LE=-7001
RN,J ACTOR:
Name
Name:
Address: o/ "'4 e5 cs
Company:
City: �O%jy �,B/6c State:
Address:
City: State:
Zip Code: c� y%ff112 Fax:
Phone No.� (3!f Li �00? Sr
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Noticd of Commencement is required.
II!Ii
SUPPLE NTAL CQNSTR flRkNN LEEN AU1/ INFORMA
EON:
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:
City:
Address:
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.
/ / 9
Signature of OwnI Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this A S day of GII 2o1 by
S�,. tti ` ar = t \a W -\ 4�N
(Name of person acknowledging)
(Signature of Notary Publi - State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced t 1, 01—
Signature of Contractor/License Holder
STATE OF FLORIDA,..
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Commission No. 5�1 • YPt (Seal RIEGNENs (Seal)
5 .. °` '= COMP 41SSION # GG
07.20 3C mission No.
ۥ +r MY ES: December 16, 20
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REVIEWS
FRONT
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UPERVISOR
PLANS
VEGETATION
SEA TURTLE ,
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
a�
RECEIVED
DATE
COMPLETED
Rev. //ZU14