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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' ' 1l0. Permit Number:
I �
RECEOVED
Building Permit Application MAY i 206
Planning an Development Services
Building an I 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.
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Address: e�
Legal Description: 2�\r-% g`7& ���_�C���Ar `a\3 •�Qco��� S�c�a� �
Property Tax ID#: 5ZA - �Y6 IZISR- IZOLQ)-�A Lot No.
Site Plan Na e: Block No.
Project Nam
Setbacks Front Back: Right Side: Left Side:
DETAILED,,DESCRIPTION OFWORK.
o�s
CO'NSTRU;CTION INFORMATION:
Additional work toe nertormed under this permit-c ec a tfal apply:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
aElectric ❑ Plumbing ❑Sprinklers ElGenerator 11 Roof
Total Sq. Ft If Construction: S . Ft.of First Floor:
Cost of Construction:$ �b(] Utilities: _Sewer ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name '(MName: NA
Address: 0`1\3 vie w'eS ��O Company:
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City: `zRkNuc� Q�O&N State:JL�-- Address:`"�t��
Zip Code: Fax: City: R`Alm State:
Phone No. Zip Code: Fax:
E-Mail: Phone No. `l��- Q 3'
Fill in fee simple Title Holder on next page(if different E-Mail: COrMICA
from the Owner listed above) State or County License:
CG e.-
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUP.,PLEMENTAL CONSTRUCTION LIEN.LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: Zip: Phone:
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certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie CounImakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con'ict 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 accordancewith the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The followingtIilding permit applications are exempt from undergoing a full concurrency review:room additions,
accessory sQctures,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.
_Signature oif Owner/Lessee/Agent Sig re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .� COUNTY OF
The forgoing,instrument wa acknowledged before me The forgoing instrument was acknowledged before me
this?day of 20\�q_by this"JQ!iday of vc-4 20,E by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known ✓ 1' Personally Known ✓ OR Produced Identification
Type of Identification Prp YGgd STELLA M.HUNTER Type of Identificationion dUgp,
Notary Public-State of Florida pp oiPay"Ua��•� STELLA M.HUNTER
* . _ C ?• .°; Notary State of Florida [
Commission No. Comr�$�gi�#FF 180552 Commission No. . ,__ ( K
c My Comm.Expires Jan 23,2019 .oP Commission#FF 180552
",'PF F%"' "%;orF o?'' My Comm.Expires Jan 23,2010 r'
Bonded through National Notar Assn.
< oug agora!NWar,:�.
Revised 07/15/2014
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DATE
COMPLETE
INITIALS
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