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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIV-D JAN 0 7 201
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)46271553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line v �`
PROPOSED IMPROVEMENT LOCATION:
Address: / �i'zdG�� �� G vcie,
Legal Description:�d7Ga r-G/,T/- .0/- Rc lo 1,11 1/Q jj� -
Property Tax ID#: �S3"��L- d �Q�1 <3 ta Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
C Cha -799 o tz-�vv irjJc o 1 c moi., .0 012i),_ and
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CONSTRUCTION INFORMATION:
iti a workto e e orme under this permit-check a appy:
AC E]Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers F]Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �o Utilities: _Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name YYaZ5 Name: k�ddtlZJl el"J
Address /& nat-C_I �� _ Company / ,- DaY Ax �'>?^��
City:, ®��' L!UG�� State:� Address: .t /�l�,�n'-e
Zip Code V1 cY k(�? Fax: Cit,�Ieyt�/�y- 41/cl e State:
Phone No.�� ��� ��o Zip Code:3 q_1 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:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIO -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 the first inspection. If you intend to obtain financing, consult with lender or an attorn y before
commencing work or recc rding yourfiNotice of Commencement.
s
_Signature of Owner/Lesse Signature of Contractor 'c o der
STATE OF FLORID >�V / STATE OF FLORID
COUNTY OF �0 COUNTY OF _ G '
The for ing instru ent was ack owledged efore me The
�7forgoing instrument was acknowledged before me
this qday of �����' 20 ��by this/ day of����Q 20 /6 by
1
(Nam person cknowle ing) (Name acknpw ging)
ignature f Notary ublic-State of Florida) ( ignature o otaryublic-State of Florida)
Pers ally Known -----OR Produced Identification Person] y Known OR Produced Identification
T e of Identification Produced Type of Identification Produced
a0AI.. %� AMARIS ISABEL GIL ��;pg
Commission No ��I�}l�i`� MMISSIONAFF914194 Commission No 2, �•'' (��AARRISISABELGIL
(I SqP C10MMISSION t FF 914194
�f a� PIRES:August 30,2019 EXPIRES:August 30,2019
°MoFr��� BondedThruBudgetNobrySONIC% �kv�e`
8vW7hru Nob Srft
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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