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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 16�a-1 I An Permit Number:
RECEIVED
•
" F OCT 302017
Building Permit Application
Planning and Development Services PERMITTINGSt. Lucie County, FL
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:
PROPOSEb,,'(N`FRQUEMENT. LOCATICIN ; .
Address: a4-kM N4V-t �P-J , <�
Legal Description:
Property Tax ID #: Ybo `^ �o vl�. Oy3A d Go ^5 Lot No.
Site Plan Name: Block No.
Project Name:
'Setbacks Front Back: Right Side: Left Side:
DETAILEDoDESCRIPTI6_N,.OF WORK.'
A- "r-L 4-r i- O R� ^d-t- A-T— CLF 4&t0l-
CONSTRUCTION [NFORMATION 71-
Additional wor to be performed urider this permit - checK all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof. Pitch
Total Sq. Ft of Construction: (,. ice'_ Sq. Ft. of First Floor:
Cost of Construction: $� �- Utilities: —Sewer —Septic Building Height:
C)WNERLESSEE
CONTRACT
OR.
Name
Name: "
Address: `7 b 3
Company:
City: k , -P�t_L_cp _ State6y—
Address:
Zip Code�J`- Fax:
City: State:
Phone No. `Z 2 r- 3-c64,
Zip Code: Fax:
E-Mail: (&- P,-, --., (�._d 1�'�
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 Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not
Name:
Address:
City: State:
Zip: Phone I`
FEE SIMPLE TITLE HOLDER: _ NotiApplicable
Name:
Address:
City:
Zip: Phone: I
OWNER/ CONTRACTOR AFFIDVIT: Applic
I certify that no work or installation has commei
St. Lucie County makes no representation that Iis
which is in conflict with any applicable Home Ow
structure. Please consult with your Home Owrier
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Narne:_
Address:
City:_
Zip:
Phone:
is hereby made to obtain a" permit to"do the work and installation as indicated.
prior to the issuance of a permit.
ting a permit will authorize the permit holder to build the subject structure
Association rules, bylaws or and covenants that may restrict or prohibit such
ociation 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,
IRecord 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 our (Notice of Commencement.
Signature of Owner/ Lessee/Contractor aslAgent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S-r- t_U C\ t-,
COUNTY OF
The forgoing instr en was acknowledgl d before me
The forgoing instrument was acknowledged before me
this 3& day of 20n by
this day of 20_ by
Name of person making statement. I
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identific tion
Type of Identification
Produced
I
Produced
(Signature of Notary Public- Stat
(Signature of Notary Public- State of Florida )
KAREN S. NIELSEN
.q FF 115637
Commission No. .,°` `�'= Comm(g��P
Commission No. (Seal)
_* = My Commission Expires
J u n e 12 , 2 018
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
COMPLETED
Rev. 8/2/17