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ILICABLE INFO MUST BE COMPLE.F:Uk APPLICATION TO BE ACCEPTED I
Permit Number: I Q ��
RECEIVED
BY
JUL 12 2018
Building Permit Application
ST. Lucie County, Permitting
ing and Development Services
ng and Code Regulation Division
Virginia Avenue, Fort Pierce FL 34982
e: (772) 462-1553 Fax: (772) 462-1578
MIT APPLICATION FOR:
Commercial Residential
ss: 005- / PPI� S� Lvu� FC
Description:
Pro �!erty Tax ID #: L
Site Plan Name:
Proj ct Name:
Set�',acks Front Back:
ionai worKto oe perrormea unaer
Mechanical Gas Tank
Electric _ Plumbing
TotI ',I Sq. Ft of Construction:
Cos of Construction: $ S 2 VO.00
permit - checK a
—Gas Piping
Sprinklers
Lot No.
Block No.
Left Side:
apply:
_ Shutters Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Building Height: _
O
NER/!RS-3EE:
CONTRA OR:
Na
Ad
Citll
Zip
Ph
E-
Fill
fro
a /3Tic, +)I,i,..w^
Name:
ress: to
Company:
�(,}- %u;,c, State: _
Code: 3 Y 9 3 3 Fax:
ne No. (%%D) YZ7-OV
Address:
City: State:
Zip Code: Fax:
Phone No
P_3�9P1 E1 Ginl. �.n
�lall:
in fee simple Title Holder on next page ( if different .
the Owner listed above)
i
E-Mail
State or County License
If valWe of construction is 2500 or more, a RECORDED Notice of Commencement is required.
5 PPl ME T L Ct*iNS ,R� , CTION : � IN �QR=MAi'ION
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address: 3b1 NvJ o,,wm�
Address: II
City: lbute— R,a,k State:
City: State: lil
Zip: 3y957 Phone0/a) 29/- 1177
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 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 our Notice of Commencement.
i
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �'j t ow opt ci
COUNTY OF
The forgoing instrument was acknowledged before me
2!o 03
The forgoing instrument was acknowledged before me
this day of _32! — 20 by
this day of 20_ by
�i c4v,
Name of person making statement
Name of person making statement.
Personally Known A OR P od ae Id'e ifieaxr n
Personally Known OR Produced Identification
Type of Identificatio " �`cj3yy� Q�
Type of Identification
Produced
Produced
es�di
�2�2j9
°' ,
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. J P- (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW1
DATE
f
RECEIVED
f
DATE
(
COMPLETED
8 I O
Rev. 8/2/13