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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �-)
Date: SI a1 , 15 Permit Number: 15(55 -430D b
RECEIVED MAY 212015
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)462-157 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: /
Address: 000 G� ` I v Lt
Legal Description:'Jh{�% �'�'/
PropertyTax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers E Generator 11 Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ V, Utilities: _Sewer O Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name Name:
Address: ALS OM S . 0&4_� Company: A1411 DtV $4Mv�.
City: State:, Address:' ✓+'1 - GZ�e�S
Zip Code: Fax: City:ti%o TJ�W—. tate:
Phone No. Zi2 -' ROO 7J21Zip Cod Fax-5Z � 7�f�� c�--
E-Mail: Phone No, r ,�
Fill in fee simple Title Holder on next page(if different E-Mail: � T-/,AhCh L� d,^rrl��b� IY1n
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: �� .•_S'1 •5, � ..rY
r ,Z Name:
Address: O Slim Ade Gb• Address:
City: '6�uo /3,t�, State: City: State:
Zip: Phone: ;1f Zip: Phone:
� y
FEE SIMPLE TITLE HOLDER: _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 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 our Notice of Commencement.
Signature o 0 ner/Agent/Lessee rTATE
e of Cont acto cense Holder
STATE OF FLORI OF FLORI
COUNTY OF COUNTY OF. ,,/,►n�i
The forgoing instru ent was acknowledged before me The forgoing instrume t was acknowledged before me
this day of 20 14 by this day of . 2014 by
(Name of person aeknow ging) (Name o per n ac ledging)
(Signature of No y Public-State of Florida) / (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification ./ Personally Known Z OR Produced Identification
Type of Identific ' Type of Identifica ' Prnril rod
RICK J MCKENNA RICK J MCKENNA
Commission No. E. '. Commission No. _ ° I�Qa
My OMMISWO)#FF069676 - COMMIS9rcJN FF069676
a:
9 oFtio EXPIRES March 5, 2018' `..', .oF�oe.•' EXPIRES March 5,2018
1(407)398-0163 FloridallotaryService.com (407)398.0153 Florida otaryeryce.com
Revised 07/15/2014
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