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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 ,5 Permit Number:
ME11'"_D JUL 4
9"Z
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 x
PERMIT APPLICATION FOR: .b
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Address: LSP 3 b L LW
Legal Description: tra (Cf1W Do ID It/ LT 14 L� j�p - 2
Property Tax ID#: 13o ) ' 6 Lot No. 2-
Site Plan Name: Block No. S�
Project Name: C,DU r
Setbacks Front Back: ight Side: Left Side:
Maw
RC L--A-Z-ELM —,v T ENS d 6 (IL
Additional work to be pertormed un er t is pemit-check all tat appy: p�
_Mechanical _Gas Tank as Piping _Shutters !�IVindows/Doors
_Electric _Plumbing _Sprinklers _Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
Name Gi d I` Name: 04-'Y7",,
Address: 6 3 07 w Company:
City: (6T C- State:_ Address: d odd
3 ���(
Zip Code: Fax: ICity: C9'7State:-N�-
Phone No. O �� ( 3 i Zip Code: `�Z �lS Fax:
E-Mail: Phone No. Q F3 Z 40
Fill in fee simple Title Holder on next page (if different E-Mail: P(e, S-e ca VA WIV, 321-M-0(03
from the Owner listed above) State or County License: Of 7
2 2-1? (a
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTA' CONSTRUCTION LIEN LAW INFORMATION`
QESIGNER ENGINEER: Not Apl`icable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: I Address:
City: S ate: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Ap licable BONDING COMPANY: Not Applicable
Name: Name:
Address: �(! Address:
City: City: —
Zip: Phone: Zip: Phone:
I
I certify that no work or installation has commence prior to the issuance of a permit.
St. Lucie County makes no representation that is gr nting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home OwnFsociatron
Assotatlon rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners 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 respect perform the work
in accordance with the approved plans,the Florida uiiding Codes and St.Lucie County Amendm t
The following building perm' plications are exe pt from undergoing a full concurrency revie :r m additions,
I i V
accessory structures,swi inJurofai
pols,fen es,walls signs,screen rooms and accessory uses t ano er non-residential use
WARNING TO OWN F Y ret Reco d a Notice of Commencement may r suit' your paying twice for
improvements to y ur pr per . A N tice aCommencement must be rec r ed a d post n the jobsite
before the first ins ectio . I you int nd to btain financing, consult with I der o an a orn y before
commencingwor or rec din ou Notic of Commencement.
Signature of OwnLAgent/Lessee Signature of Counr tar/License HoldSTATE OF FL STATE OF FLO DA
COUNTY OF COUNTY OFOR K;E
The forgoing i strument was ac}cn wledge fore me The for oing ins umt s cknowleZ�ged by re me
this day f, �L 20 A by this day o �J(J
PETER A CAFAR15 III PETER A CAFARQ III
(Name of person acknowl (Name of person acknowle ing)
I
( ignature Of Notary Public-State of Florida I (Si naotary Public-State bf Flor da )
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission NO. EE t7at64mmission No. EE t7dt64 arPL Notk�trcState of Florioa {
,►'YPr� Notary Public State of Florida a
, Kari M Riccaboni
Kari M Ric Boni 7 c < fA Commission EE 174 t64
my t, 111111150vll Cr 114'U' of flog Expires OS?2$12016 of flc Expires OSR$12416
Revised 07/15/2014
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DATE
COMPLETE
INITIALS
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