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Date: Per Number:
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Building. Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft.34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ✓ Residential.
PERMIT APPLICATION FOR:
Address:
Legal Description. -
Property Tax ID#: 13,3S- 9 0,7- D0l0.?--- coo- Lot No.
Site Plan Name: Block No...
Project Name:
Setbacks Front Back: Right Side: : 'Left Side:
9'-
gG�otaA-) 1 .
4
Witionalwork to .e pe orme under tis permit-c ec a that appy:
Zric
anical _Gas Tank _Gas Piping _Shutters -Windows/Doors
Plumbing _Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ utilities: Sewer _Septic 'Building Height:
Nam Name: L E.
Address: l � Company:
City: State: Addre Pl 0 - Q
Zip Code: Fax: City: State
Phone No'9 �_14R- O &/, Zip Codq.3y 9y6 Fax:
E-Mail: Phone No. X79-
Fill in fee simple Title Holder on next page(if different E-Mail:M;t-e-(a- paid . Q hQ o--�tzaal. C o
from the Owner listed above) State or County License:_F e-" 1.3 60 9 _
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if value of construction is 2500 or more,a RECORDED Notice of commencement is required.
DESIGNER/ENGINEER: ible Not Applicable
CO PA •
_
Name: AD hiii Name: t;r
Address: Address:
City: State: City; State'
Zip: Phone: Zip:.. Phones
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COM Y: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone-
OWNER/CONTR ff R AFFIQVIT:Application is hereby made to obtain.a permit to do the work,and installation as indicated.
l.,certify that no:woik'or.installation has co►i�inenced p f for to tFie 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 lenor an attorney before
commencingwork or recordingour Notice.of.Commencement.
Signature of Owner/Agent essee S!gKipfiof Contracto i ic6se older
STATE OF FLORIDA t - STATE OF FLORIDA
COUNTY OF COUNTY OF ST W-C-1
The forgoing instrum. nt was acknowledged before me The forgping.lnstrument was acknowledged before me
-this*. day of d� 1: O by. this: �4lay of n-1 .20?Sby... ::.
lel e--
(Name of persod acknowledging) (Name of person acknowledging)
Aa X I 1p: j2 01 '
(Signature of Notary Public-State f Florida). (Signature of l tary Public-Sta of Florida)
Personalty Known OR Produced Iden"ti, Personally Known OR Produced Identification
Type of identification.`Produced: f' �� Ty0e.of Identification Produced
Commission No. A5 °:`; `l,`�A Q��g vic Commission No. 0 Pia<,
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REVIEWS FRONTrAa� ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014