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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: !//� Permit Number: �<42 00
I
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RECEIVE
Building Permit Application APR ' 1 2016
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:
F'ROPt!)5ED LNPROUEMENI"//LOCATION:
Address:l0 JX moi- anI AP 7
Legal Description:
Property Tax ID#: 3 9/;U—TOO"��,3�3" 000-1 Lot No.
Site Plan Name: M,tq /ly eon Block No.
Project Name' P✓t a melftvH
Setbacks Fr ont Back: Right Side: Left Side:_
DETAILED DRSCR(1PTION OF WORK:
d :rh
G� ez1 1'-61
opl l�G�.�TlciJ I�GG. .
I
1CONSTfflONl[NFORMATION:
AClaitional work to be performed under this permit-check a tat appy:
Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electri _Plumbing _Sprinklers _Genbeator _Roof
Total Sq. Ft o :Construction: Sq. Ft.of First Floor:
ao
Cost of Cons(ruction: $ / d(2 Utilities: —Sewer _Septic Building Height:
NER./1LE�S�SEE: CONTRACTOR:
Name_pC5'?A` .J M ftnr- o" Name: �J L-1-YL, j''e
Address: /Z� Litl - fliJA, 17/ /07 Company:_Coad'l•'l
City: ® J/ Lr'cf e State: A' Address: 0 3� al. Z""A 041.1/
Zip Code: 3 /95.7 Fax: ide 14 City: � ®rjriGG State:Wit.
Phone No. 3 el0. 7 9"15- Zip Code: 47�jkl,� Fax:27,J-L16
E-Mail: g�/� Phone No 1-
i
Fill in fee simple Title Holder on next page(if different E-Mail J"D ..I, ��✓ 7G
from the Oiwner listed above) State or County License S7CG !
if value of co struction is 2500 or more,a RECORDED Notice of Commencement is required.
Wil
Sl1}PPLEMENTA► CONSTfARATION LFEN IRMY INIFflR�MATfttkI®N:
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 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 work or recording our Notice of Commencement.
gn re of Own e Lessee/Agent ;���*:�A; ignature of Contra or/License Holder
STATE OF FLORIDA "�� •••�" STATE OF FLORIDA ,
COUNTY OF COUNTY OF NZ
The forgoing instrument was acknowledged f�ri8 The forgoing instrument was acknowledged befor
20�(� a mem this da 2 b w
this_L day of �J ��, Y (& Y
y4 r iF se m
��y�/pyy�� C Q C
V+! v`+e-� /l� C Tic � ''';:V,Y•`:,';.
(Name of person acknowledging) a;N (Name of person acknowledging) M`�
�>
a � :
v� TEE
TES
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(Signature of N- ary Public-State of Florida ) (Signature of Noicfry Public-State of Florid )
- _n
Personally Known OR Produced Identification Personally Known /OR Produced Identifi tib '
Type of Identification Type of Identification a
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v. 7/2014