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Gate: !2141-02Y,f/S' Permit Number: ���-. b-"t-S)--'t1
Building Permit Application
Planning and Development Services
Building and Qxle Flegulation Division
2300 Virginia Avenue,Fort PierceFL34982
Phone:(772)462-1553 Fax (772)462-1578 Commercial Fasidentied
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Legal Description:
Property Tax ID# 3 �•�'7 - 7 f d - Q 00..3 -6 a o Lot No. `1
Ste Plan Nemec Block No.
Project Name:_ �fr'7 4e
Setbacks Front Bade Fight Sde: Left Sde:
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OONST XnON'INIOFUATION:
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HVAC I.;1 Gas Tank ❑C:esRping _Stutters �Wndows✓Doors
Electric Plumbing E]$rinkllers LJ Generator 0Ibof
Total 4 Ft of Construction: Ft.of First Floor:
Cost of Construction:$ (S !N
s"a- o Utilities]Swer 7 Septic Building Height:
OWNIRIESO-R.-
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Named.1- A"Wr K 2 l�e,� Name: : oJOIW
Address_ $O )�c .1C1 GAJ-�i ( 7II1pa(ly, �S S Gtc '
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Zip Code: Fax aty: ,res c gate:X-C
Rhone No. `7 7n2 s er-r 4 Zip Cade: 3 `f r-z,..2. Fax
E-Mail. Phone No. 3 -7 -7
36
Fits in fee simpleTitleHolder on next page(if different E-Mail: '►s &,,,
from the Owner listed above) gate or County License: CSC ff g 16-3
If value of construction is$2500 or more,a ®Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE BOLDER: 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 Countvmakes 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 our Notice of Commencement.
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_Signature o Owner/Lessee/Agee fure of Contractor/License Hcid Imo'
STATE OF FLORIDA STATE OF FLORIDA „
COUNTY OF 1t�c� a COUNTY OF. W. ,
The forgoing instru ent was acknowledged before me The forging instrum t was acknowledged before me
this idayof :�i"; ( 20 Eby this��dayof� ,'f i` f 20 by
(Name of perso acknowledging) (Name of person a ow edging)
(Signature of Notary Public-State of Florida ) ignature of Not ry Public-State of Florida)
Personally Known Ll_�OR Produced Identification Personally Known O Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. _7
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Revised 07115/2014 . Jeinnoe yv aluuog WWWAARONNOFARY,wm
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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