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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1 \ t u ar� Permit Number: a
Date: y��
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Building Permit Applic ioi
Pbnning and Develapment Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Reside
Phone: (772) 462-1553 Fax: (772) 462.1578 Commercial
PERMIT TYPE:
Address:
Property Tax ID #:
Sitp Plan Name:
2
✓Electric ^Plumbing ^Sprinklers ^Ve11C1OLV1
Total Sq. Ft of Construction: Sq. Ft. of First Floor:_
Cost of Construction: $ � i 0 fz Utilities: _Sewer _Septic
'Jot to;Yr4, Address:
Zip Code: Fax: City: 2a
Phone No. Zip Code:
E-Mail: Phone No71-7z—
FIII in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License_
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required -
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
aa�d3y3
RECEIVED .
FEB 14 ?0?0
icie county,
tial
I Lot No.
Block No.
wilding Height:
Fax:
OWN
s GlflE
DESIGNER ENGINEER:
Not Applicable
MORTGAGE COMPANY: u
,Not Applicable
Name:
Name:
Address:
Address: I
City:
Stater
City: i 1
State:
Zip: Phone
Zip: Phone: I
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address: I
City:
City: I
Zip: Phone:
Zip: Phone: 1
a
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permitto do the woik and installation as indicated.
I certify that no work or installation has commenced priorto 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 reviewyour 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 CountyAmendments!
i
The following building permit applications are exempt from undergoing a full concurrencir review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessor uses to anoth'r 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 COMMENCEMENT1 MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
wrrw Ynuw 1 FNOFO OR AN ATTFIRNFY BFFnRE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License
STATE OF FLORID n,�
(Holder
COUSTATE OF NTY OF O L6 'thIr
COUNTY OF ,(
The forgoing inst ant was acknowledged before me
The forgoing instru entwas acknowledged before me
�tb
this is,of ' 6 by
this clay of 20� by
p
C: -
Name of person mating st ent.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known li OR Produced Identif o�p
Type of Identifirr,,22�jloy
Produced
Type of Identificati' n
Produced Ala,
I
f-
(Sign eg Rabli. ob5zadda)
(Signa a of otary Publlc- p ri
2
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Commis '
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commission No. l7�e L (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
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SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
j
COMPLETED
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