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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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
PROPOSED IMPROVEMENT
Address: N 14G1LtnJ �D IUr -ST L1, c 3 °! S�3
Legal Description: 9 i VR-',' Polo'1C- u fUl T 0 " PA/3 T C 13 -L R r]i Z L 6 T I
(MRP 3412/ S) foA 32 lCo - Ila Ll �
Property Tax ID#: 314 l q "576--665-q - Do 6 Lot No.��
Site Plan Name: Block No. 9 a
Project Name:
Setbacks Front Back: Right Side: Left Side:,
DETAILED DESCRIPTION :OF WORK
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3.-1
CQNSTRUCTI(3N INFOKM_ ION 9 - l
Additional work toe e orme under this permit-c ec� a appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers 11 Generator E] Roof
Total Sq. Ft of Construction: ��//�� M S . Ft.of First Floor:
Cost of Construction:$ 21J�� Utilities:O Sewer El Septic Building Height:
OWNER/LESSEE ?CONTRACTOR
Name (,Rb Lu e-Ve,2 Ohl VeSTrnU0T LLC. N Name: 14-� t/¢V�Le�O
Address: 5c)L1ri N A//4 */ao '4 Company: '1'1/Lou/"✓"_7z_1zi,L'/c,Ley'S��NC
City: �RD 'P►-t;--Z C F- State; Address: laa I S W KkcA Lckcg el 4r2VI_t4
Zip Code: 3L/"'! (4 C1 Fax: 1 )9,-3XP4-t cc c1l G City: buc-i-e_ State:+L
Phone No. Zip Code: 22 q2M 3 Fax: 77 2 3 q Lko t'l�
E-Mail: Phone No. Co
Fill in fee simple Title Holder on next page(if different E-Mail: VYI GLV-I'rl(I Ge, k-j_J[Sbl cL.Irld-
from the Owner listed above)' State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU'PPLIE MENTAL.CONSTRUCTI0N'.LIE4LAW INFORMATION: F
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 inspe tion. If you intend to obtain financing, cosuit with lender or an attorney before
commen ' or recordin our Notice of Commencemen,
s
SZE
e of Owner/Lessee/Agent Si n ure of Contractor/License Holder
ILI
STF FLORID S ATE OF FLORIDA
COUNTY OF ��,�„� _ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ID day of 20 Eby this ()day ofJQ b 20 LAO._by
OXA e orb � �1 !)LNQpcQ rt,
(Name of person acknowledging) (Name of person acknowledging)
( ignature of Notary Public- ate of Florida) ignatu�Notarytate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produ ed
F�- rnv��g�o ` �3s'•-t o -��ti•�
Commission No. (Seal) Commission No. <�R���a,, (Sez
SHAHNA ING
Notary Public_ RAM )
LASHAHNA INGRAM ;o w � M State
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* �,�OFFIORO`,` Commission res 20,<"018
_• w• My Comm.Expires Dec 20,2018 ��•��" #FF 177299
Revised 07/1.5/2'014 Bonded through National Notar
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION 1 SEA TURTLE MANGROVE
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DATE
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