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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:' 3 C)0 s
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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
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PERMIT APPLICATION FOR:
PRQPOS.ED1INI?ROVEMENT LOCATION = `' r t
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Address: 6 � N S Ef- �,VcQ �U►"
Legal Description: Podd_1c pt"'J® S {-kgms - ('I-1-astr Ttjd - p3 "43' 33 LOTA6 ea 3���-
Property Tax ID#: 131A - S'e� • C9 1 1 6• oc® • Lot No.
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Site Plan Name: .!I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAtt_ED DESCRIPTIONbO�F WORK `3
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w„o r &L- l4=bo t:`r" ,j 677 r.^ i.
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CONSTRI CTION 6N 64 ATION
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Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters j _Windows/Doors
Electric _&Plumbing _Sprinklers _Generator ' _Roof
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Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OWNERjLESSE CONTRACTOR
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Name Ffl"D Name: a-r�S�o (4 oac,"i stynerJ(:�'2.
Address: 1 oto o 'S T" S r ire a4,6 v iL, Company: 3cr49,y-q4 DAcwS hl✓b •+ Nbo
City: iMtAimi RcvcW State: ,FI 'h�-Address: l73 -SN:J_,�lLt�y.p uo 7�LR.4Cc-
Zip Code: '3 313 cl Fax: :City: &,:1- State: P-'1
Phone No. ,.5Z f• 702• b3.15- ,Zip Code: - Fax:
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E-Mail: 3 iA6 •r►�o►L, , Phone No 7 701 3 7® dNl7
Fill in fee simple Title Holder on next page(if different E-Mail 3 ccri Q a M•N,X(„rrlS rivill1rJll cwi
from.the Owner listed above) State or County License 658eu2!3tilSZ,
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SU, PLI�/I >�1,7Lf;fNS1UTl4N 1IV LAS/ 1NfRMAT101 ' 52 ,
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:
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 in conflict with any applicable Home Owners Association rules,:bylaws or anal-covenants that may reArict.or prohibit such
structure.Please.consult with your Home Owners Association and teview your deed for-any restrictions which may apply.
In consideration of thegi�anting of this requested permit,I da'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 acc-essory'uses-to another n' or-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 recording our Notice of Commencement.
ignat wner/Less. Agent Signature of actor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYCIF �, C: COUNTY OFks �: .. ..:
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this day of —_NIA.0►�- 20� by this day of (nQAC, I:, 20)6 by
(N a of p rsUn acknowledging) (Name of persoA acknowledging)
JITPersonally
gnature of Notary Public-St a of Florida} atur of Notary Public-Soof Florida)
Known OR Produced Identification Personally Knowe !„s„ Produced Identification
e of Identification Type of Identific iwoli�sso, LASHAy R .
duced. Produced =r .��.
„* comm., State ofFtbrld
Coma issior�No. F_§.(Seal}. , mmission N hJ ; ;, ComExPU ,,;0 2Lt ,r
v Bonded si&n` FF 17�'
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REVIEWS FRONT a�0 .� � ,,,� PERMS; LAMS VEGETATION SEA TURTLE MANGROVE
COUNT �pi� I �Y a,qn t,; EVIEIA/ *` VIEW ' ' REVIEW REVIEW - REVIEW
DATE INVUEINf11N VW'
RECEIVED ,
DATE
COMPLETED
Rev.7/2014