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ALL APPLICABLE IN O MU BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: SCANNED Permit Number: C
BY
St. Lucie County RECEIVED
• Building Permit Application p
Planning and Development Services APR 10 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial YI/— Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line WI Y1dQ0Ns
Address: g600 s. oeean Drive lUnit Hc9 Jensen Bearh, FL 34q57
Legal Description: F_mpf ess ocn1domini Ltm W n l t 309
Property Tax ID#: Ll,50z-iO7,0-001a-0o0-(0 Lot No.
Site Plan Name: —ffi1P Empres f Block No.
Project Name: ;c- Ineidn- ResI(JPn.I:n -
Setbacks Front Back: Right Side: Left Side:
IRernove +- rep>a,ee doors vvi+h non-i mpac-E Cus-bmer ho-S
new ew-Wers. Fcmaje and rep aaxe wInaows W1++-) nan—
i rn aae4
Gas Tank
❑Gas Piping
_ Shutters
ILIv
windows/Doors
0
Plumbing
OSprinklers
E Generator
D
Roof
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 15400 • (:13
S Ft. of First Floor:
Utilities: Sewer O Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
=
Name
4 U, ncio Schnel
r
Name: bouid WP(odf°
Address:Qbn0 K1r Drive Unit 309
TmpbrfV4flffC )s
•
city: Jensen RPf a la m .' State: FL
ZipCode: �P1o' �' 3�PJ �_ ;Fax:
Phone No. 77Z- 34; q
rdress: 3510.SE DIXLI°- WNR
�City:`'S� �L �_ <.�e State - FL
Zip Code: 3tiQQ� Faz: 772 ZP(c a4(ol
Phone No. "777_'728(6,60459
E-Mail: Ld@WebQ ihor.cc)m
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Perm i-t5. q )QSSPr0S@Ahnl A -Corn
State or County License: I213(o3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
NotApplicable
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:
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 postedpp the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an atq y before
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA �n V� n COUNTY OF STATECIFFLORIDA y� aj o
COUNTY OF I/6 I 1 I
ThefQlgoing instr nowledggd-before me The oing instrument acknowledge efore me
thiV J_ day of Ph"
k20 _by thisf �n ry waday of 20 by
Lei 1 hneid I w d Lo_Fhade
(Name of person acknowledging) (Name of person acknowledging)
�I tC�C�u U'0if`Q�(�fl�
(Signature of Poary Public- State of Florida) (Signature of taryPubli State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced P'l DL Type of Identification Produced
Commission No.
Revised 07/1
Commission 8 FF 929255
My Comm. Expires Oct 20, 2019
Commission No.
�``Commisslog,ajFF 929255
' _My Comm. Expires Oct 20, 2019
[I,ri1M iu.,.,n� NoHnnal Nnlary Assn
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