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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �-IU�I QII
SCANNED
e1 • M O F '" BY RECEIVED
St. Lucie County
Building Permit Application APR 04 2019
Planning and DevelopmenYServices aerIt. Lucing LuriDepartment
R. e County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPOSED INPROVEMENT LOCATION:
Address: LkQb$ SUtJRi.SE (3L.Jb F"oRT PSGeCC FL.34R8'2-
PropertyTaxlD#:40y-SO\-0112- 500-`r Lot No. I
Site Plan Name: S\Aeo VaLoc-A- a:GtA Block No. 35
Project Name: Sli6l� jai
DETAILED DESCRIPTION OF WORK:
9,EL0Q_K—'SDM of StiED (I7-X Ila i
CONSTRUCTION INFORMATION:
Additional work to be performed under 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 Sq. Ft. of First Floor:
Cost of Constructionsotiso, to Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Lee Ann �. $ui}
Name:
Address: 5 0 9 Su.,riSe Blvd.
Company:
-LA
City: Fo2'r Py4o2.Cr: Stater
Zip Code: i9`rs z Fax: 14 1 A
Phone No.
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: i.ClogsGnp17Do.exim
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
1
f.,
SUPPLEMENTAL CONSTRUCTION LIEN LAW IN
DESIGNER ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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,aork or recording your Notice of Commencement.
Signature of 0 essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FL A
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The fo going instrument was acknowledged before me
The forgoing instrument wa cknowledged before me
this day of 204_ by
Annmm _�LL
this _ day of 20_ by
Name of person making statement.
Name of person aking statement.
Personally Known OR Produced Identification
Personally K wn OR Produced Identification
Type of Iden ification
Type of Id tification
Produced -�l_�P,�
Produce
'Slgiiiature of Notary P lic-State of Fio . a)
(Signature of Notary Public -State of Florida )
Commission No. 11:••"'d•••.. [ASRQ*AIW�RAM•RAiMING
Commission No. (Seal)
MYCOMMISSION k GG 27501i0
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Rev. 9/2b/18 I ' I /