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,t'PLICABLE INFO MUST BE COMPLETED FOR APPLICATiONTO BE ACCEPTED / �7
,Date: m'c/ eiLe J PermitNumber: t r`
'I RECEIVED
Building Permit Application JUL 2 0 .2015
Planning and Development SWCes
Building and Code Regulation Division
2.300 VirgWoAvenue,FOrt Pierce FL 34982•
Phone:(772)462-3.553 Fax:(772)452-3.578 Commercial Residential
PERMIT APPUCiAT10N FOR:
Address: /7� ralel'1 �
Legal description:
Property Tax id Aazur_ � GtG!f _ Lot No
Site Plan Name: -- Block No.
Project Name: -
Setbacks Front_ Back: __ Right Side: Left Side:
Aciditional work pertormed under this permit-c ec all Mat apply:
V/Mechanical !Gas Tank Gas Wiping —Shutters Windows/'Doors
,,,,,_Electric Plumbing sprinklers Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor.
Cost of Constructs'on:$ Utilities: Sewer Septic Building Height: �,-
Name Name: L tts -_5&M_ r &n
Address: 17,0d ,t!5Y . 2 Company...�� �1.Air ��s 5 ,1�C.. -
city. . o _ State. Address:-1W-5 S�- aI t I Io ,r ►�.� r -
Zip Dade: y944Y Fax: ��?��'!� �. city: :& "c T ILACtC ct State.rL.
Phone No. / Zip Code: 34 ig Fax: `,��33L I16
E-Mail: Phone No.
Fill.In fee simple Tithe Holder an next page(lf different E-Mail: !�_( to it ell" r r)-n= ,
from the Owner listed above} state or County License:
1f Vaisre of Wnstruetion IS2SWat MQrQ,a RECORDEn Notice of Cornmen+ce ntert Is requ6•ed.
as
DESiGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: - - _ .. Name:
Address: --.__.-- -----_------_. _-_-- Address:.
City: State: City: State-
Zip: Phone: Zip: Phond,
FEE SIiVIPLIE TITLE HOi,DER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City.
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the vuprk and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit-
St.Lucie Count 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 Buildigg 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 recordin your Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder ,
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 'S-T L�U C i e COUNTY OF 4. 5; 1, r
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this io day of Ce.P«,___ . -_20 :r by 'this,day of 20111 by
UriS Amman
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Sta of Florida) (Signature of Notary Public-State of rids)
Personally Known i! OR Produced Identification-_ Personally Known ✓ OR Produced Identification
Type of identification Produced P 5 SM Igi Type of identification Produced
r-C j S q4p My CO%iABBION lI EE ,rRy k,e�, "—
Commission No. .. ai) EXPIRES:April 4,2017 Commission No. L7 r-& o7a� 'P§dOr
-'' 11 E� EXPMES:April 201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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em G° 1747 ('170 16401�a U