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ALL.APPLICABLE INFO I�IU TBE CO LE FOR APPLICATION TO BE ACCEPTED
Date: (� Permit Number:
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: To Select from dropbox, click yarrow at the end of line
41.!
Address: c_ 1.m Lanz-, N'(4-rW— SZ
Legal Description: w 11 a �. N D rt
W tis qS #7 DSS 2 Z
Property Tax ID#:_3 C/2 1)1) Z 000 --S Lot No.
Site Plan Name: . �. Block No. .
Project Name: s C 464, k
Setbacks Front Back: Right Side: Left Side: .
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Additionalwork�rto be er ormed under this permit-check all that
, apply:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric I Plumbing Sprinklers Generator 2Roof
Total Sq. Ft of Construction: ISDD S�• (Q r S . Ft. of First Floor: .
Cost of Construction: $ �n Utilities:-Sewer Septic Building Height: / Ff. .
;i �`�" ,f,• '� Y } 4 •'t i ,zf�S� s.x-;. t r x.. ,
�� CONTR$ACTOR,
k'`THV' ° ..'e:.>.n.i.,_br..x.. ..s�. ;_ .'�>i..�.v..;�...,,.sem. .p..5.�� .'' ..a` x....:,a�,C.. .f.�S ,?: _� :�� ,. yl�� �jx .� �k..�.
Name Name: hlnctS, o—Q211
Address:. Company: n 0
City:
0&(3— -� �til,(�(,�, State: _ Address: Alle �.
Zip Code:•?z�Q�iS'L Fax: City: tater
Phone No.9� 9(oq - 231y Zip Code: Fak-77'2)3
E-Mail: Phone No •7 2-
Fill in fee simple Title Holder on next page (if different E-Mail: 3 , i0dkjS Ce4
from the Owner listed above) State or County License: ('(03 2V
If-value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION,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 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 th ' 'nspection. If ou intend to obtain financing, con with lender or an attorney before
com cin rk or reco our Notice of Commenceme .
s
_Signature of Owner/Lessee/ASignature of Contractor/Licen older
STATE OF COUNTY OF FLORIDA s - /��� COUNTY OF STATE OF FLORIDA 5 , t
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this 23 day of 20 Ir by this 2-3 day of f 20 /s by
NZADLS .l�d��N a�a s. KosAry
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known ✓, OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No=otPa::�Bi, RAI ICE A,ROES&O Commission No. ar p,,. Seal
�4': % BRUCE A R�ESSNER
* MY COMMISSION 8 FF 211275 * * MY COMMISSION A FF 211275
FXPIRF&April 8,2019�'+rf DtArlftb:April
IN Bonded Thru Budget Notary Se�rices N'+rFOF�o��Oe Bonded Thru Budget Notary Services
Revised 07/15M14
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS