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COMPL'c'i c0 FOR APPLICATION TO BE ACCEPTED
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Permit Number: \`%C) 5- C)154z\
RECEIVED
Building Permit Applicat on MAY 2 2 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
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: L
Address: 01 /uIVI K s (�'- S Wup
Legal Description: �I ���A-qu"e S 05,
Property Tax ID #:?� - ��% - (y(n - �'% Lot No.
Site Plan Name: Block No.
Project Name: em_lif-pL)Xuyu f 0
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be nertormed under tis permit, -c ec a app y:
11HVAC _ Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Ll oof Roof pitch
Total Sq. Ft of Construction:]%� S . Ft. of First Floor:
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Cost of Construction: $ 3 , �� - Utilities: _Sewer 0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name IrL) rz o- )
Name:
Company:
Addre IL
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City: 2S"I i�-rC! �L' State: 1:::,L
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Address: E
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Zip Code: 34qR(o Fax:
City:
State: F4--
Phone No. 4C)
Zip Code:-5t4qq-7
Fax: -170�0; 7 -7
E-Mail:
Phone No.�
Fill in fee simple Title Holder on next page ( if different
E-Mail:
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State or County icense: rCC
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from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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t`FPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: I Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
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 requestedl 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 Noticelof 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
comm ci g workAr recording your Notice of Commencement.
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Ow Lessee ontractor as Agent'for Owner
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Signature of Contra or/License Holder
I A
STATE OF FLORIDA
COUNTY OF
COUNTY OF (a v` itN
I
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of
this c9Z,? day of MQ 20,r2<by
Nam4 of person making statement
Lonally Known OR Produced Identification
Name of person making statement
Personally Known _� OR Produced Identification
Type of Identification I
Type of Identification
Produced {,^
I
Produced
(Signature f Notary Public- Stat f Aida )
(Signature f Notary Public- St o lorida )
Commission No. 5 (Seal)
Commission No. �C BEccA lea-
My COMMISSION # G(}91863
�CACRESTIFO
'oFaoP" EXPIRES: May 17,2021
E3 S: May 17
2021
REVI ���P
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
T_
COMPLETED
tev. 8/2/17