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ALL APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ( —(J r15 Permit Number:
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- 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)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
.PROPOSED IMPROVEMENT LOCATION:
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Address:
Legal Description: i A't-s
Property Tax ID#: 1-3 2 —C32 — 0oc) --9 Lot No.
Site Plan Name: Block No.
Project Name: /5_4z/zz
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
pep 10-ez, &2_1VV6V_5_
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_HVAC _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$/-do. Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: L S S J'C-
Address/: 5 � �v Company:
City: Dvc� � ts✓ State:_ Address: O�
Zip Code: Fax: City:)* /�-a`� State: -
Phone No. q f# ,f Zip Code: 3 ��� Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: e67�
from the Owner listed above) Stat or County License:
If value of construction is$2500 or more,a RECORDED Notice of 1
required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
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 your Notice of Commencement.
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_Signat e f caner see/Agent Sign ure n act icense Holder
STATE OF FLORI — STATE F FLOR
COUNTY OF COUNTY OF ,
The forgoing ins
t ment was acknowledged before me The forgoing' strument was acknowled ed,before me this
this 01 day of 20�y day of 20 7by
Ap
( of pers acknowledging) (Namer acknowledging)
(Signa a of Notaryate of Flori ) (Signature of Notary Publi tate of Flori )
Personally Known OR Produced Identification Personally Known OR Produced Identification
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Type of Identification Pr dui@d.., nAWN MII nNr i.. Type of Identification ed
DAWNMIL
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Notary Public-State of FL:r da .`<�" " '�
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Commission No. _• * My C(%ml�xpires Nl?.'22,2017 Commission No. '_. My CoWA-0ires Mar 22;2017
%;q, o;� Commission#EE 677571 �, *off; Commission EE 87.7571
one roug a ions Notary ssn. Bonded Through National Notary
Revised 07/15/2014
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