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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1'U01_E>"01029_
- _ Building Permit Application ,
Planning and Development Services 1
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
dential
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resi
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PERMIT APPLICATION FOR:%
PROP�SED IN'P.ROV M�EN�LOCATI.��N .P ' � �� _
Address: -360Z _J(,_cc4dA Jto AUv .)Q,4- �P 25-f7 V(o
Legal Description:3[l&tzA pn PIA?-A lei✓J Px.,,r aeplA- L C 1( 2-71
Property Tax ID#: 000 — ''I Lot No.
Site Plan Name: I Block No.
Project Name:
*Setbacks Front Back: Right Side: Left Side:
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CaNSTR'UCTICI 11
INFORMATION € 4} �� , ti � �
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itiona wor to a pe orme un er t is permit-c ec a that appy: !
_Mechanical _Gas Tank _Gas Piping _Shutte'rs _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: CSP -�o -72d Sq. Ft.of First Floor:
Cost of Construction: $ Qb c'IJ Utilities: =Sewer _iSeptic Building Height:
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OWNER%LESSEE � � ��¢r � CONTRAw, 0'R:
.id=s i,c r:., s
Name Name:
Address: 2- c��° J-A Company:
City: R-e� State:t(A- i Address:
Zip Code:OLS Lf Fax: City:- f State:
Phone No. � 2- q-7 S- �3�Cp Zp Code: ;'�; Fax:
E-Mail:
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.;
S�l1�PPLEIVIIENTAL C®NRSRjUCTION TEN L.AV1/ INF®RIIVIAl'I. N:
DESIGN��S�g/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Addre�-,ss -'c�c�2 _�s ear� � �4ti,yS Address:
City: 91 A State: _V-J_ City: State:
Zip: . Phone--F'7 Z-- 4-?$'- 1�3o(,> 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 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 attorney before
commencing workpT Lecording your Notice of Commencement.
a!e ofd/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of r'f\Q\ACN4_201�o by this day of 20_ by
(Name f person acknowledging) (Name of person acknowledging)
4ig�LaturAof Notary Pubricl State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
P odu d Produced
:a3-q.wa.ayI-0
Commission No. (Seal) -Commission No. (Seal)
LASHAHNAiNngAm
'�". .`�•: Notary Pub is-State of Florida
REVIEWS FRO 0 N1NWW- m: V650DR8 PLANS VEGETATION SEA TURTLE MANGROVE
COU o,F VIEWrimiss on REIV17MA9 REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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