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LICABLE INFO MUST BE COMPLE` z 'OR APPLICATION TO BE ACCEPTED
&A N �� \ Permit Number:
RECEIVED
• C �5'�; AUG 15 2018
Building Permit Application
P tt'n
Pitning and Development Services S1. Lucie County, ermi i g
Bu' ing and Code Regulation Division SCAN�l�
23 10 Virginia Avenue, Fort Pierce FL 34982
PH II � one: (772) 462-1553 Fax: (772) 462-1578 Commerci Sidential
P 0MIT APPLICATION FOR: �--P, i\C,V, — � d*0N
Description:
eraty Tia r #. I �� 11�0 ��i/ �7 ! (� Lot No.
Site!, Ian Name: Block No.
Proj l ct Name-
Set cks Front Back:
AaaI ional worK D
I Mechanical
' I Electric
TotalliSa. Ft of Con
►9
S l f cq to s
I Lt a + C. �S
Right Side: Left Side:
C -� Cit rr�va,,cQ ^xJ
perrormea unaer tnis permit- cnecK aii tnat apply:
_ Gas Tank —Gas Piping Shutters
Plumbing _ Sprinklers _ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
NER/LESEE'NT
A OR:
Na i�
Ad
a Cf LAC— I
Name:
Company:
ess:16142.f c 2b i�' 5f
llr C� State: P/
ode- 3�960 Fax:
Address:
it
Zip,
City: State:
Pho
a No. `77.2— ✓'01 %.2,0-Z-
Zip Code: Fax:
E-Mjril:
Phone No
II7 fee simple Title Holder on next page ( if different
? the Owner listed above)
II'I
Fill
t
fry
E-Mail
State or County License'
If valu;o of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S �F' � L � EN i, GCiNSiRUti' UN I�N 001 FQR�M 4
DESIGNER/ENGINEER: _Not A licable
PP
MORTGAGE COMPANY: Not Applicable':
Name: ��� ,c
¢
shame:
Address:
Address:
City: Stat
City: State:
J
Zip: Phone
Zip: Phone: i,
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 structured k,
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 99f Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was ackn ledged before me
this I day of Q O y 20� by
this day of 20_ by
Name of person making statement.
Name of person makings tement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Ident!'ffcation
Type of Identificatio
Produced `C
Produced
I .
(Signature of Notary -
•:.",. DEANNAMARIEGNE' S
(Signatu of Notary Public- State of Florida )
,.•�
Commission No. my S #GGU2202
- •
Commission No. (Seal)
Q: I:XFIRE��ber16,20
" °• ota publicUndenvritem
Bonded
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
C7I � �
1
DATE
COMPLETED
Rev. 8/2/17