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Date: '" Permitfiber:
SCANNED
BY
Building. Permit Application St. Lucle count
Planning and Development services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Fl.34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial tV Residential .
PERM IT APPLICATION FOR:, ,
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Address: yleWA d
Legal Description: Oi5l, Z��jLz�" h�s3 �l poi i�/�J N 2 Lo� /Aar `a 3 4,W i /
Property Tax lD #: Z ��a2 6�0�— 90d7 . Lot No.
Site Plan Name: —011"&g5g it104e Block No..
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be performed un ert is permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters _ Windows/Doors ..
_ Electric. _ Plumbing —Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Y a466 Sq. R. of First Floor:'
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
Name a ,6 0
Name': 5 o '{f A,k 5,79t%
Address:
Company:
City: �� i Tlr . ZIA- State:
Address:
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city: State:lld
Zip Code: Fax:
Phone No. ;Z 7-;Z y2 9 ZZ L/
Zip Code:441Fax:
E-Mail:
Phone No. 77 z. — .3,3 2 -- /G Cl
E-Mail:
Fill in fee simple Title Holder on next page (if different
State or County License:
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement Is required.
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
City:
Zip: Phone:
MORTGAGE COMPANY:. _ Not Applicable
Name:
Address:
City: Statec
Zip;, Phone:
BONDING COMPANY: _Not Applicable
Address:
Zip: Phone:
OWNER/ CONTRACTOR AFFIEWIT Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify thatno Work'or lnstallation.has commenced prior to the issuance o'f.a permit.
St. Lucie County makes no representation that is granting a permit Mill 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 concurrenry 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 olrecording vour Notice of Commencement.
ignatur of O / Age Lessee
atur f Co ctor/Li nse Holder
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STATE OF FLORID
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ATE OF FLORIDA
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COUNTY OF
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UNTY OF
The fo oing instrument was acknowledged before me
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e for oing instru ent was acknowledged before m
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(Signature of No�a�Public-State of oflo ida—
Persona now iii OR Produced Identification
Type of Il eoh Produced',
Commission No. (Seal)
(Signature gffNotary Pub'Iic-State of4lorida )
Per ally Kno OR Produced Identification
Type of Identi
Commission No.
(Seal)
REVIEWS I FRONT I ZONING SUPERVISOR PLANS I VEGETATION I SEATURTLE I MANGROVE
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