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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION:TO BE ACCEPTED
Date: 6 -�S Permit Number:. \5 g 'G61G5
ti RECEIVED OCT 16 2015
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 arrow at the end of line U q C I
j R( 'flPa i'PiiPRUEM£'NT Lt3ATtON
Address:' I Lift r&
Legal Description: FJ` T` t—1) TIT r }ct -
oto o 6 D�.
Property Tax ID#:_'✓ r Lot No.
Site Pian Name: Block No.
Project Name:
Setbacks Front_ Back: Right Sider Left Side:
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Additional Work to e e Orme un er t is permit—c ecf a apply:
1HVAC .Gas Tank 0Gas Piping _Shutters O Windows/Doors
Electric 0 Plumbing :.L_jSprinkiers Generator Roof
Total Sq. Ft of Construction: fSq. Fl
of
of First Floor:
Cost of Construction:S 7_` S�. Utilit es: Sewer L 1 Septic Building Height:
oWt�El3/I�;=SSE I;GC�iTRpAC; caR x,
dame'-r(M i 5 ..r- ' "`� i Names
Address: Z5 9 L# ' 1 C �1��-L''£� ' Ia Company: A-in, Tb4-
E` CtY• N,6 - ,4 ►. i State:� 1 Address: ' v '� ti t. l�ts'
I Zip.Code: 12q`C � Fax: ! City:-VA c State:t" P
Phone;No -�3C'J�' Zip Code: ; Fax:]I:Z_ � f
E-Mail: Phone fVO. r� ~ ` �?(')_CI
` Fill.in fee simple Title bolder on next page(if different 1 E-Mail: "�tvN. �i 4{�sLC�y�ct2al�6`��ii/t,� Luh
Ifrom the Owner listed above) State or County License: f "
If value of construction is S250o or more,a RECORDED Notice of Commencement,ia required.
r
FOR
DESIGNER/ENGINEER: _Not Applicable -MORTGAGE COMPANY: —Not-Applicable
Name: Name:
Address: Address:
City: State: I City: State:
Zip: Phone: _ I Zip: Phone:
I FEE SIMPLE TITLE HOLDER:. Not.Applicable80NDINCa COMPANY: Not Applicable
Name: Name: i
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 Count makes no representation that is granting a permit will authorize tie permit holder to-build the subject structure
which is in con list with any applicable Horne Owners Association rules,bylaws or and covenants-that may restrict or.pr ohibit such
structure..Please corisult with your Home Owners Association and review your deed for any restrictions which may apply.
in consideration ofthe granting ofthis 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 exemptfrom undergoing a full concurrency review:.room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses-to another noxi-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in.your paying taulce for
improvements to your property.A Notice of Commencement must-be recorded and posted on the jobsite
before the first'inspectiom If you intend to obtain financing,..cansult with lender or an attorney before
commencing.work or recording your Notice of Commencement.
w Signatu e of Cc trgctor)€ice ;i older '
r tgnart{ui�efOwner/tes,ee g f�f r r
,q £ h 21499.!
STd1'€OF FLORID ,� STATE OF FLORIDA
COUNTY Of ' ;� L.� � : � COUNTY OF
The forgoing instrument was,ac€cnowled ed before me E
The far ing instr ent was a knowledged-before me B R g
thisday of �+u- �z 06 24 i 5 b� this day.of k'•i i 20 byV-0 aejj }
A
;Name,of person acknowledgi (game of person acknowledging) I
{Signature of Nota Pu lic-State of Florida) {Signature df Notary P I' _State of Florida I
P rsonally Kno OR Produced Identification rsonally Kno OR Produced Identification
Typ entification Prod ceType-af✓dentification Produced-
Commission No.i u"":, {seal}'MOiliblA S1A57fission No.
i iMA 3.$TACK
L _ " Ndit •$�of Ffo Id
CA1r may 3.2017 s .� llag�S.20
Revised 07/15.201 "l", d fOF F 001" E 884200
�11N01)aJ Notary Assn. >
REVIEWS FRONT .ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER 'REVIEW i REVIEW REVIEW REVIEW REVIEW REVIEW
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