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All APPLICABLE INFO MUST BE COMPLETED FORIAPPLICATION TO BE ACCEPTED
Date: 11 15 I Permit Number:
a . RECEI'."71D SEP 171015
MOP
uilding 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:w-� ,,.�doLO as r
Address: 56 W-1
Legal Description: `��>? b d vU 1 -1✓Lrl �5' l
Property Tax ID#: ��0 l�� 033 )�'I d0®- (0 Lot No.�
Site Plan Name: A C, v,&v-e, Block No. l
Project Name:
Setbacks Front Back: Might Side: Left Side:
- �ao1�5 - ✓G w5 (nL AW Al MP✓f-T
lfAl
: U
trona wor to a pe orme un er t is pe mit- c ec a t at app y
_Mechanical _Gas Tank tas Piping _Shutters _Windows/Doors
_Electric _Plumbing ,!Sprinklers ^Generator _Roof
Total Sq. Ft of Construction: I Sq. Ft.of First Floor:
Cost of Construction: $ $`3 2q-'5 Utilities: —Sewer —Septic Building Height:
Name 611 Pv- -e-
U 5 ✓LJ _ Name: t -A . ee c:0_0
Address: (pU 9 Uln► 1'c Company: EOwgr ffpM e 6044&b,S �1.
City: l 7 e,,c e Q State:I Address: -7,9 1 61
Zip Code: Fax:
City: r i2,ho state:
Phone No. 72L-40 ((7
Zip Code 9'3
Fax:
E-Mail: I P ne No. .L -7s -
Fill in fee simple Title Holder on next page(If di erent Z _1.43 0G 3
from the OwnOr listed above) State or GetwAy License: `�
If value of construction is 2500 or more,a RECORDED!Notice of Commencement is equired.
SUPPLEIVIE'NTAL CONSTRUCThpN LIEN LAW 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 Amendmllltoi�
The following building perm' plications are exempt from undergoing a full concurrency reviem additions,
accessory structures,swi in pools,fen es,walls,signs,screen rooms and accessory uses t aer non-residential use
WARNING TC OWN R:Y ur fai re t Record a Notice of Commencement m /der
suyour paying twice for
improvements to y ur pr per .A N tice of Commencement must be rec d a d post n the jobsite
before the first ins ectio . I you int nd to obtain financing, consult with I o an a orn y before
commencingwor or rec din you Notice of Commencement.
Signature of Own Agent/Lessee Signature of Contr for/License Holder
STATE OF FLi-�'
DA STATE OF FLO DA
COUNTY//OFcE COUNTY OF +cE
The forgoing i strum !-was { owledget-eby
e me The fo" 'ng ins um t was t knowledgeVby
re me
this day f , 20 this day o 20
PETER A CAFAR6 III PETER A CAFARO III
(Name of person acknowl (Name of person acknowle ing
L-A
( ignature f Notary Public-State of F orida) (Si nature o Notary Public State f 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 174!64 +�'v`1ti"�'( mmission No. EE 174164 aYP1'_ N '(51Rr'WkStateof Florida {
Yo�T aL�� Notary Public State of Florida ;
c Kari M RiCcaboni
Kari M RiCCaboni y T My Commission EE 174164
VALKS ro y o,no Expires 050812010
Revised 07/15/2014 } Expires 05!2812016 ,
.��.�.,.
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