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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 0
Date: Permit Number. el, (
RECEIVED
Building Permit Application DEC 2 2 2015
Planning and Development Services PER;IAITTING
Building and Code Regulation Division St. Lucie count vt FL
2300 Virginia Avenue,Fort Pierce FL 34982 V/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
MONO
M_M11
Address:
Legal Description:j�i vej-`PC —Uf�4 f 5 60
2-1 N o r 37 0(q -o_c)4�
Prop rty Tax ID#: S`Z19 " 510 - 01q-2 ' ()( () ) " � Lot No.
Site Plan Name: Block No.
Project Name: a r
Setbacks Front Back: Right Side: Left Side:
i lona wor toe e Orme un er is permit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric Plumbing U Sprinklers 1:1Generator 0 Roof
Total Sq. Ft of Construction: ! 2-' Sq. Ft.of First Floor:
r7
Cost of Construction:$ _ Utilities:[]Sewer[ Septic Building Height:
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r.- , a,P.. ..p s x � au•° h`,!., s., ` .`�d `ia$ra I s 5, a,-, � � M.,v=s �r ' �`i✓': . ,.�.'E..>€s'`•- �'�... �+a'' r�
Name CC/ _ Name: CQ-
Address: Company: Q U
City: - rr State: Address:
Zip Coder`tt� C)�a_ Fax: City:—rr �� ? �� _ State:
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Phone No. �A S S.S( - "t 14 Z Zip Code: {,.E' Fax:�7 I � _14 ?4((,P
E-Mail: /� { Phone No. J
Fill in fee simple Title Holder on next page(if different E-Mail: iQ C e ah
from the Owner listed above) State or County Li nse:_ I Z 2-019 0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
_N_M"V INEW
DESIGNER/ENGINEER: Not Applicable r MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: WNot 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 reqording your Notice of Commencement.
1
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_Signature of Own Lessee/Agent Signat a of Contractor/License Halder
STATE OF FLORIDA r STATE OF FLORID.�A/
COUNTY OF h Ch Cf(L COUNTY OF L L i G}
The forgoing instr rnent was acknowledged�efore me The for oing instrument was acknowledg d before me
thisday of 20 JL by this day of -0 20 by
A-
(Name of pers6fi acknowledging)) {Name of pe on acknowledging}
{Signatu a of PA* -State of Florida} {Signature of WoUary Public-State of Florida}
Personally Known OR Produced Identification Personally Known I/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. _ JEA DANIELLE YOGEL =,,,.„• JEANETRNIELLE VOGEL
••.,{;�."�'•••: Commission No. .*...
MY COMMISSION#FFI 14946 MY COMMISSION#FF114946
EXPIRES April 21, 20f8— 8 April 21,2018
Revised 07/15/2014 (407)398.0153 FloridallotaryService.com (407)398-0153 FloridallotaryService.com
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