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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - /0. 117-17 Permit Number: 1710- map
SCANNED
t L By RECEIVED
Planning and Development Services BulidllnuglP�h Application OCT 12 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Okbippstb iM0ROVEMMfLbCAT'IO'N'
Address: 74 2-o S. DC2QA I c. In 14
Legal Description: Sancl-binl1ar Villas CoMomin'iam 0 614
Property Tax ID #: 3SLIQ _66q- 0033-000-b Lot No. 60�6_f
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: — Right Side: LeftSide:
011TAILIEUDIESCRIPTION'OFW RK"'
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C�ONST,RU'C-�TIO'-NIN-'F'ORMATION�"-�'�-",-�
Additionalwor a e e armed under this permit- cheCK an [napply:
Ill " IT'asTank DGas F . - —Shutters Windows/Doors
11 Electric El Plumbing []Sprinklers 1:1 Generator Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ /4/1/
S Ft of First Floor:
Utilitiescn SewerEl Septic
Building Height:
�OWNLAAESSEE:.' -: �' "� � � - � - ! ,
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Name a_0C'QPk
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Name:.
Address: I L4 2 6 S - bman-Ir. d (piq
Company:a,,9W,!f:/_7,-'>/,/
Adc1ress:/6S'9_ 5- 10&7,y 71A��e� elc?,-72V
City: 'rZy' I 7ds�� State: 14.1-1
Zip Code: -92 '118 Fax:
Phone No. 5-&l -
City: Tansizn 6 -k State: Pl-
-Zip Code: Fax:
Phone No. 0 - 116cl
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E- M a i 1: A,�DD a A!� , &zp o?
State or County License: 67,dc- 05-4?3 5-/
if value of construction is $2SOO or more, a RECORDED Notice of Commencement is required.
.SU PPLE ME NTAL C 0 ST R Q C-TION -, LIEW L AW IN FORM �T, 10 li
DESIGN ER/ENGI NEER: 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 Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conAct with any applicable Home Owners Association rules, bylaws or anscovenants 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 Agent for Owner
STATE OF FLORIDA
COUNTYOF
The fppW9'9 instrument waycknowledged before me
th!sL:;;) day of 20 Zffy
STATE OF FLORIDA
COUNTY OF
Th e forgoin instrument was acknowledged before me
thi Fay of
20 1-7by
(Name cif person acknowledging)
(Name of person acknowledging)
m u),� AAj At Am &D6�
(Signature of Notary Public- State of Florida )
Personally Known / OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
WJ A��A, �?J MLA75�
(Signature of Notary Public- State of Florida )
Personally Known V/ OR Produced Identification
Type of Identification Produced
Commission No.
MELISA ARMENTO
[.7 MY COMMISSION# GG 056886 IR%SN'DmmberJ2r8,620W
. '41 EXPIRES: December28,2020
Revised 07/15/2014
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