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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L%0 Permit Number:'
s
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
Address: . l.Z�� - �ril NN Aa*
Legal Description: (4j¢y 3i,-,,V— ll�.�.� t �1 t'A4.k e 131�L Q)( L-0,T- I S
Property Tax ID#: 31-t I 6 1 Z Lot No.
Site Plan Name: Block No.
Project Name: 'PY1 d5AA1.1C1 IZYA'! 1 2 e-
r
Setbacks Front Back: Right Side: Left Side:
2�`c �is=a: ..¢'fie: -e`.` `'- �` .ti"°•s,n �.�:'�...s �, .-.r ��:`skeT,R.-..S
Additional work toe Derformed under tispermit-check all tbat appy:
HVAC Gas Tank ❑Gas Piping 1:1_Shutters Windows/Doors
Electric El Plumbing Sprinklers Generator F] Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ SCJ _ Utilities: Sewer Septic Building Height:
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Name t440,-� FSA 4,i ecr I ( ' Name: Peter A Cafaro III
Address: ) Z7 N►>r?( Gn I cvQ.--AW- Company: Lowe's Home Centers, LLC
City: ?ork State: F` Address: P.O. Box 781993
Zip Code: 3 i,,t9 �3 _ Fax: City: Orladno State:FL
Phone No. i•03 1 ^�2_I.' 31 L4 10 Zip Code: 32878-1993 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CGC1508417
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: I Address:
City: State: ? City: State:
Zip: Phone: I Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: Not Applicable
Name: Name:
I Address: Address:
City: City: I
Zip: Phone: Zip: Phone: i
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 iPt,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 propert . A Notice of Commencement must be recorded and posted on the jobsite
before the first inspec " . yo intend to obtain financing, consult with lender or orney before
commencinR wor recordi Notice of Commencement.
I
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I Signature of / ent/Les e Signature o Contra �A�z:�
rise
I
STATE OF FLOR! STATE OF FLORI {
COUNTY OF si_c % COUNTY OF SLC
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The f rq ening instrument was�cknowlecled efor�me ( The forgoing instrument wals acknowledg ore me
this ay of 20 y this• t_' ay of 201W by
Peter Cafaro III �v��� " Peter Carara III
(Name of perslo ackno ((Name of person ac gin
(Signature of Notary Public-State of Florida) (Signature of lNotary Public-State of Florida) j
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
i
"'"'" (SeHll}TCH 60000K Commission No.
i Commission No. _ BOCOOK
I Notary Public•State of Florida " I
a� –�Y Cnm-� — - - .� _ No Public State of Florida
L Revised 0%/15J 0 ° Bonded
#EEF1T 176 6g =+rF �p` Comm,ss:on # EE 176869
nded Throuon National Notary Assn. " � Bonded Through N,;iona'Notary Assn.
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REVIEWS ` FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
i COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
i DATE j 1
RECEIVED I !
DATE
ICOMPLETED