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LL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �- � I- �� Permit Number:
r x DECEIVE®
Building Permit Application AUG1 q 2
1 015
Planning and Development Services 1
Building and Code Regulation Division ,
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
1.
PROPOSED IIVIP.ROVEMENT-LOCATION
Address:
Legal Description:
Property Tax ID#: �� - �� - lJoc)(D" - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEDbESCRIPTI -- O:F WORK 4
r Y .�.
P
CONSTRUCTION INFORMATION:
Additional'worK toe ,er orme un er t is permit-check a appy:
'11HVAC 11 Gas Tank Das Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing []Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
CA
Cost of Construction:$ �I�S�� Utilities: _Sewer 0 Septic Building Height:
OWNER/L`ESSEE CONTRACTOR
-r,. k48 t
Nam Name:
Address: l 6�Lla I CL= Company: «-
City: State:T-F_ Address- L
Zip Code: Fax: City: State:
Phone No. Zip Code: SZ F &J
Faax: - 01-9L
E-Mail: Phone No - - O3 11
Fill in fee simple Title Holder on next page(if different E-Mail: 1C.` a ab`-
from the Owner listed above) State or County License: a l3c&�)L L UP3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
RLEMENTA.CO'NSTRU;CTION LIEN LAUV INFORMATION :
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 our Notice of Commencement.
s
_Signa �ORIDA
Owner/Lessee/Agent Sig t e of Con ractor/ icense Holder
STATE �_ I STATE FLORIDAQ
COUNTY OF COUNTY OF J�C
The forgoing instru ent was acknowledged before me The fo�r ay
instrument was acl nowledged before me
this day of 20 by this day of 20 L by
(Name of person acknowledging) (Name of person acknowledging)
-�
(Signature o Notary Public-State of Florida) (Signature of Notar4y/Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
l aur it, BRENDAAARTINEZ 1W%_1 1184
Commission No \ a�•�S mission No Q ,,o,�n•• {„Seal) BRENDA MARTINEZ
* = 4�ty Public=State of FI IttCa°. ;: 4.'s Notary Public-State of FI d
.•; Commission N FF 2316 5 Commission#E FF 2316
S! p4y Comm.Bonded throw fires May
y 31./Assn. '•.'rF,F F�5yComm.Expires May 31,
ph a) .......
.•.. Bonded tkm*N ftwal NNot
Revised 07/15/2014 T
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DATE
COMPLETE
INITIALS