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ALL APPLICABLE MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: R zsINFO
zo 1 q SCANNED Permit Number:
BY
St. Lucie County
Building Permit Application
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 Residential
PERMIT APPLICATION FOR:
Address: 6102 Spruce Drive. �,± ple f-c,e i �0I. 3 �) �8Z
Legal Description-
Property Tax I D #: J? 'I 0 z- — b I ' O 9 2.3 — b 0 O 7 Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
aaitionaiworKtoDe
11HVAC
Electric
errormea
unaertnispermit- cnecKall
Gas Tank Gas Piping In _
Plumbing Sprinklers M
apply:
Shutters Windows/Doors
Generator E]Roof
®
Total Sq. Ft of Construction:
Cost of Construction: $ 5 0o xo
S Ft. of First Floor: _
Utilities:cnSewer 0Septic
:Name. _ V
Address: ae'I.' ry C Z)\J
City: State:
-
Zip Code: 3 0182- Fax:
Phone No. 1-7 Z- Li Z 9 —11 S 3
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Building Height:
Name:
Company:,
Address:
City: State:
Zip Code: Fax:
Phone No.
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
a
r�-
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of Owner/ gent/ LesseP Signature of Contractor/,License Holder
STATE OF FLORIDA STATE OF FLORID ,,
COUNTY OF - COUNTY OF 4
The forgoing instr ment was acknowled ed before me The for oing instrument was acknowledged before me
this day of 20� by this�� day o 20-Dby
(N a of person a owledging) (Name of person acknovkI dging )
�J/ V
(Sig a i
ure of Notary Public- Statkof Florida) Sig t re of Notary Public- St of Florida )
sonally Known OR roduced Identific tion Personally Known OR Produced Identification
Type of IdentificatioP�nrodu{Ced �
-A , Type of Identification Produced
•,�ti"pr LASHAHNA INGRAM
Commission No. DS ;�1�'YP`�%(Sea.,,, LASHAHNAINGRAM C mission No.& -0565 9 '; EXPIS: December 20, 2014
OOMMIS ION # EE 05055 (SY6Q� MMISSION#EE050558
FIE
FYr�!RES: ecember 20, 20 4 % 'g' N`'• : Bonded Thru Notary Public Underwriters
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
I ST. LUCIE COUNTY UTILITIES - P.O. BOX 728 FT. PIERCE, FL 34982
NAME _�11r��t'+J�''�k\ Gcio IC! `
St. Lucie County - ¢f � 9 kJ, -Aar j J
08-28-2014 09 ; 38 8:00 :00 ACCT. # d """�"
15398/5229
LANGEL-COULD, KIMB
6109 SPRUCE DR
FORT PIERCE
FL 34982
Amount Tendered: 518.00
Amount Paid: 518.00
Change Due: 0.00
Thank You
User ID: RODRIGUEZM
SERVICE ADDRESS ;_i t 0 9 sr) r u c P_ � f-1 V L
SUBDIVISION _ LOT BLOCK
BILLINGADDRESS � C���; a a C�`C) D\/ F
PHONE # 7 7c:)� _ ` MOVE IN/CLOSING DATE
This application hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/ _
FED ID 7 % — s (o Q)
SPOUSE SOCIAL SEC._ / ^�` • -�„
OFFICE USE ONLY
DATE RECEIVED CASH CHK # RECEIVED BY t`'`` �\ kf