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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11
Date: a' I'1• UQ Permit Number: � lf� � � 1
RECEIVED
61
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Building Permit Application FEB 17 2016
Planning and Development Services PEMOITCING..� Lucie County, FL
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 �-
PROPOSED IMPROVEMENT'LOCATION
Address: �� J ��5�"►
Legal Description:
Property Tax ID#: 561 1 M� " 1000" Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED,DESCRIPTION OF WORK
CONSTRUCTION INFORMATION.
Additional work to be nertormed under t ispermit—check all ill
apply:HVAC I—J Gas Tank E]Gas Piping _Shutters a Windows/Doors
alectric ❑ Plumbing Sprinklers ElGenerator E] Roof
Total Sq. Ft of Construction: S�Ft.I of First Floor:
Cost of Construction:$ _ / �G�C�6 / _ Utilities: L_J Sewer F]Septic Building Height:
01NNER/LESSEE CONTRACTOR:"
Name j7-jt,l �- v > Name:
Address: 511fA4k9 )@A Company:. �3�s��
City:y' 1 A-m-.4 Stater Address:/T pp '!
Zip Code_34'g, —7 Fax: City: State:
Phone No.TZA-3A—qlb Zip Code:34b / Fax:
E-Mail: Phone No. oZ—-Y —"U3
Fill in fee simple Title Holder on next page(if different E-Mail: Y1 12,414v;� Q_
from the Owner listed above) State or County Lice nse:,EC ooh q/3
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 the first inspection. If you intend to obtain financing, consult with tender or an attorney before
commencing w rk or recording our Notice of Commencement.
el 0
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_Signature o e `Agent Signature of Contr ctor/License Holder
STATE OF FLORIDASTATE OF/rte�A „�n COUNTY OF FLORIDA mn
COUNTY OF
The for ing instrulne t was acknowledged before me The foring instrum t was acknowledged before me
this ay of 20&I—by this Kay of 20 V by
Fmnv,,- R7wfT'(& Rl
(Name of person ackno ledging) (Name of person ackno ledging)
(Signature of Not Public-State of Florida) (Signature of Nota• uublic-State of Florida)
Personally Known V/ OR Produced Identification Personally Known p OR Produced Identification
Type of Identification Produced Type of Identification Produced
G��{{ Shi ��a..,,,.,, Shirley i nson
Commission No.Ee 4 65 _ Notary Public EE �3 a (Se tary Public
Commission No. °6 to of Florida
"A (Sea of Florida
My commission No.EE 6339 9 %;o F�;�`'My commission No.EE 833969
er 10,eUlb es: ep em er 10,2016
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS