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ALLAPPLICABLE INFO MUST BEOOM R=FaORAPPLIC nON TO BEACCs7nD
Date: 5'a25 I� Permit Number: 15 O
y; RECEIVED MAY 2 a 2015
- - Building Permit Application
Planning and Development SBrvioes
Building and Oode Fbgulation Division
2300 Virginia Avenue,Fort Fierce FL W82
Phone: (772)462-1553 Fax (772)462-1578 Commercial R)ddential ✓
PER4ITAPPUCA110N FOR To Select from dropbox, click arrow at the end of line QOM 1�ea�1•cf'
PROPOS IM'PROVEN ENT LOCA11ON:
Address ,Z.0
Legal Description: A-bD �9S 1 ,+ S t!Or 3c c'—k`3�ti1
Property Tax ID#. 33 Z�7-��S- �< —CY7�,°-�I Lot No. S
Ste Plan Name: Block No.
Project Name:
Setbacks Front Back: fight Sde: Left Sde:
DETAIL®
DEM9PTION OF WORK
oONsrwa1oN INFORMATION:
Addit ional worK to De orm under ff perms -cheCK a I appy:
OwAC: C3sTank ❑GasRping Siutters O Windows(Doors
OBectric 17FRumbing O1prinklers E Generator Fmof
Total 31. R of Construction: . R.of First Floor:
Cost of Construction:$ �O� DC7 c9 Utilities Sewer[1,%ptic Building Height:
MIST !L CONTRACTOR
Name. dv� y� Name: r�
Address: 82c,\ Company: T\AcA Cpc�� tnL,
Cttyk- ±JA- IL,,—aa aate:-'(!�C Address: C_.Lt t
Zp Oode: .31f9 Pc, Fax City: zt.,vA s� l t_ c_- gate: FL
Phone No.-')-)L__48,4-.may ( (z!, Zp Code: Fax -7-)-2_,6C)-7_-787LJ
E-Mail: Phone No. 17--- 04►g- l 3 3 3
FII in fee simple Title Holder on next page(if different E-Mail: T i c1 a\ c-)c-Ax Sao is @ c-o tnnc o,. , na j
from the Owner listed above) gate or County License: C OC I -iL, �ac-F?,
If value of construction is$2500 or more,a RBOORDED Notice of Commencement is required.
'JPPLEM ENTAL OONSMCTI ON U EN LAW I NFOWAl1ON:
DE9GNER ENGINEE2 _Not Applicable M ORTIGAGEOOM PANY: _Not Applicable
Name: Name:
Address: Address:
City: nate: City: Mate:
Zip: Phone: Zip: Phone:
FEE SM RETITLE HOLDER Not Applicable BONDING OOMPANY: 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.
3.Lucie Gbuntymakes 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 OwnersAssodation rules,bylaws or and covenantsthat may,restrict or prohibit such
structure.Please consult with your Home OwnersAssociation 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 a000rdancewith the approved plans,the Florida Building Codesand a.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 usesto another non-residential use
WARNING TO OWNER Your failure to Record a Notice of Commencement may result in your paying twice for.
improvementsto your property.A Notice of Commencement must be reoorded 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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_Sgn re of Orvner/L�Agent 9gn a of Gbntractor/License Holder
STA OF FLORI DA, 1 �(.��,L-� STATE OF FLOPo DA
OOUNTY OF OOUNTY OF
The ng instrument was acknowledged me The forgoing instrument was acknowledged before me
this,Uay of 20�by thiQ lay of 2015 by
�as&ti w La.am-s W
(Name of person adkno ging) (Name of person acknowledging)
J01_006, -J-Z&
(Sgnature of Notary Pu I' Gate of Florida) (8 ature of Notary Public-E1of Florida)
Personally KnownORProduced Identification Personally Known ORProduced Identification
Type of Identifical1t11iion1 oduoed Type of Identification��1P1roduoed
Gbmmission . a OP
J Commission No. _ Brenda 'U►illi
J.( '11ia
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