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All APPLICABiE INFO MUST BE COMP L 6D FOR APPLICATION To BE ACCEPTED /
Date: \C) S3\ xq PermitNumber:
X SCANNED
Q BY L�'ljl RECEIVED
St. Lucie Countv
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Planning and Development ST. Lucie County, Permitting
Code n ewes
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X>cx
PERMITTYPE: �c F�im, I IC ¢S,c& n -haj7 _
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID Lot No.
Site Plan Name: fop L- rn 8 PQ E E Z E Block No.
Project Name: /Yi o /2 / A
DETAILED DESCRIPTION OF WORK:
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CONRUCTIOI�9.869FO�M/TI®i�
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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 4�/;L Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: /3,30
Cost of Construction: $ _ Utilities: —Sewer �( Septic Building Height:
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®UI/iVER/LESSEE:. •.+
,.: .""- „CONTRA'�Gf�R;
(Name H1rr,1" c,rL I LC_
Name:__�leh..
`Address:%�J��I d r'
P i-
City: ) 4 a k- State: FL
Address:1/7,z.5 S FA,S4 (Vet, , Slv,
Zip Code:1 '5V9 d/6 Fax: / qA. Ali Si
City: 11, L State: FL
Phone No. 7 ') . IAI A IY61)
Zip Code:,""qr % Fax: % 7.1- &q -1 ry/.55
E-Mail: 2/ nNoan`Uw� [ PFrrAr llmv _Orn
Phone No M) - l�)-2 `%d�7j
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Fall In fee simple Title Holder on next page (if different
E-Mail rc & i I SY)t 5 c Fl
State or County License C'/,3 C
from the Owner Basted above)
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 o-f• Commencement is required,
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DESIGNER/ENGINEER: r
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
Signature
STATE OI
COUNTY
The forgoing instrument was acknowledged before me
thi�day of D(- 4 20(� by
Personally Known OR Produced Identification
Type of Identification
Produced ,aarvup", RHONDASROWE
+ •• ��f Commission#GG1O46!
Expires May 19, 2021
D1 iO � ° f NOW7Son
T VLl1/1 A_ /1 .n9?._. of 9onded T�ry BuEgo
(Sighature of Notary public- State of Florida )
Holder
STATE OF FLORIDA
COUNTY OF .41- l , r i
The forgoing instrument was acknowledged before me
this
_44dayof 2012 by
Name o erson making statement. S
✓ Personally Known OR Produced Identification
Type of Identification
of Notary Public- State
— RHONDASROWE
� Commission#GG1O4656
r Expires May 19, 2021
Commission No. (Seal) Commission No. (Seal)
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