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All APPLICABLE INFO MUST BE COMPLETED F
Date:
APPLICATION TO BE ACCEPTED I ak�-
Permit Number: �l
r � �"WED
RECEIVED
u�. _� M...... Building Permit Application
MAY-'95 1018
Planning and Development Services P2ltnitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 I Commercial Residential �_
PERMIT APPLICATION FOR: c LOrl2le4-(— /ks-- #-GU, 74 uL2 pCp46�
Address: (1 34
Legal Description:
Property Tax ID#: 116/"66W- 016 i
Site Plan Name:
Project Name:
Setbacks Front may° Back:
t3
�o I Right Side
/) 210 A O-P • P4 &C--Z-
cvlv,a t r%t.i�IVIVAlv�,�rtiv�xr
Lot NQ%CP
Block No. 9 �L—
Additional work to; be pertormed under this per,mit —check all that apply:
_Mechanical ' _ Gas Tank _'Gas Piping —Shutters _ Windows/Doors
I
Electric _ Plumbing . _I Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: JCV-1 Sq. Ft. of First Floor: Zoe
Cost of Construction: $ �3.�15.,� Utilities: —Sewer —Septic Building Height:
Name
Address:`Compan1.y: nt ,�► �ti J/ems /iL
City: / / e `'State` Address: 16gco / .5iAwy
�
Zip Code: Fax: City:y66 Q&CA , IPI a State:
Phone N . Z - 6/r& Zip Code: 3,aNPD Fax:
E-Mail: l % 6 - effyo Phone Nobl?) E; ro s I9(o
Fill in fee simple Title Holder on next page ( if different E-Mail 8,a-d on glos El ec. Q P.,,, • CdU^
from the Owner listed above) I - State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
St;PPL MENTAL CQNSTR')CT�QN LIEN LAIN IN
CiRNAT1QN
_ .
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: ;<;
"Narlre
Address:
°•Address:
City: ~ ' State:
;City: , +i ... 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:
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 that
covenants 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 our Notice of Commencement.
igna re of Owner Lessee/Contractor as Agent for Owner
nature of Con actor/TZerZ
STATE OF FLORID -At //
�?• ZOLfc
STA OF FLORIDA,�
COUNTY OF
COUN F 'V�
The for oing instrument was acknowledged before me
The forping in u ent w s a owledged before me
thisaL day of\'�(�(�� �J 20� by
this � day 201• by
. 5: 2&P Q Z e"
ask 10 L-t fy]
(Name of person acknoaedledg g)
(Name of er c owl dg )
UL
Notary Publt State Flo '
(Signs re of Notary Public- State of Florida)
(Sig ture of of a )
Personally Known OR Produced Identification
Personally Known OR Produced Identi tion
Type of Identification
Produced ='_�;¢':Prp�j�
i � ion
_ Florida PW 0
• : -
Commission No� (Seal)��FFo�.'Cci�
`• Commission tt GG 121631
iEDyPiryViio.2o21 ' (Seal)
eo�dad ttgF Naftral he
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