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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n �-7
Date: SCANNED Permit Number: ri � - F b2 I D
oft BY
St. Lucie County RECEOVED
Building Permit Application OCT 12 2017
Planning and Development Services
Building and Code Regulation Division PERMI 1 G
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie .0 rlty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR To Select from dropbox, click arrow at the end of line
PROROSED.IMPROVEMENTLOGATION:,.:
Address: 7'{30�S. Dcgowi -Dr. 32[
Legal Description: Sand ,r o lloX Y i ots Coridomtrtit uYA 6 — u n & 3 21
Property Tax ID#: 35;U -%03 -0016- 000-8 Lot No._1?_?
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK,
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U'1Qot,J 11����Xl'1-pX1t' GB=a
3 is 1-0.
CONSTRUC-TIbN'INFORMATION>
E1HVAC IJ Gas Tank ❑Gas Piping
11 Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 14141
Shutters Windows/Doors
Generator _Roof = Roof pitch
S Ft. of First Floor: _
Utilities: Sewer E] Septic
Building Height:
OWNER/LESSEE
CONTRACT R
Name Kawc>n
L. ReAoyo ot
Name:
Address: 9430S. Deean_'hr• 32112)
Company:a,�Ve,G7VIV
Address:/6.179_9_/O(oTj/ C/l�,cloCTN
City: TenSQ.n &GC k State: FL•
Zip Code: 3N4a7 Fax:
Phone No. at h 59 - 9531
City: '*Uv'l State: �L
Zip Code:S3 418 Fax:
Phone No. 57&s -
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License: e446C 05-'?3 S/
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION =
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:
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
as
STATE OF FLORIDA
COUNTY OF
The forgpypg instrument was acknowledged before me
thi day of —.Z aA/ 20 ! eby
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this ,5 Taay of � � 20 %!by
I Q\ r .ha)A C �)Q j Q \(lord cYnr l�n
(Name of person acknowledging ) o Game of person acknow edging )
(Signature of Notary Public- State of Florida )
Personally Known -,ubOR Produced Identification
Type of Identification Produced
Commission No. (Seal)
(Signature of Notary Public -State of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
MY COMMISSION# GG 056886 MY COMMISSION #GG056886
Revised07/15/201 ZEXPIRES: December2}al�N�mr4Z0�
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