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All APPLICABLE
rrINFO
//MUST
/BE COMPLETED FOR APPLICATION TO BE ACCEPTED �" 11 �
Date: l� ' t!' ' c� Permit Number: ' �¢ 0 Co' 0
• - RECEIVED
- - -��IIIIIIIIIIIIIIII11W Building Permit Application
Planning and Development Services JUN 16 2016
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:
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PROP FEIINPROVEMENT LOCATI`QN:
Address: I�{ - 3 S'f' i=`� PLe06Z:, CL , 4-7
Legal Description: ��t l�c/�5 5 b f1C �L�C� i •7—3S--40 uW prcFCneOen13 L-V
L.p� S
2e2 kJ b a-1 61 A-6,
Property Tax ID#: 2-411 -70 R fib 10 Doe l Lot No.
Site Plan Name: C45-5 tye)u-tg- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAIjLED DE�S:CRIPTIC}N ,•F WOR+ : '
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=@@�NSTRUCTIO INFORMATION:
AdditionalWorFt—obeperformedun er t is—permit—check allAhat appy:
_Mechalnical _Gas Tank Gas Piping' Shutters . _Windows/Doors
Electric _Plumbing _Sprinklers Generator 4X�t/Roof
' F {fConstruction: 00:120f?TotaISq Sq Ft__of First.Floor:
Cost of Construction:$ �fZG�p Utilities: _Sewer _Septic Building Height:
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OWNER/LESSEE: '� CONTRACTO'R:
Name_ JT xmi✓S 4 V1A� _S 94N K_ Name: 5R,--QE-&J
Address: :�;LN S-3,1 .5--T Company: 6- L202V els tL,
City: Pc�2Gc' State:�Z Address: �7�'7C Dt.�11W `7Z_ .A�
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Zip Code:� �Ei,Lf Fax: City:,ei� aeozeAE�� State: Ci
PhoneNo: 77-2-, LlLi-LgOSs ' Zip Code: 3c�r'lb�Z Fax: 7)7,
E-Mail: Phone No -77L, aU, d'O'f7
Fill in fee simple Title Holder on next page(if different E-Mail V?OyaLg-
_g 6-044q �
from the Owner listed above) State or County License C'GGdS�"�7 ID
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CQNSTRUCl'ION LIEN LAW__27101PO ATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: 7'2-0K' 614 S<— G1PZ. Address:
City: 95L State: City: State:
Zip: 3%,;5-'2_ 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 toy roperty. A Notice of Commencement must be recor Ord posted on the jobsite
before the first i ec you intend to obtain financing, consult wit ender ttorney before
commencin rk ecord' g your Notice of Commencement.
Signature of Owner ee/Con ractor as Agent for Owner Signature ntra e
STATE OF FLORIDA ""
b STATE OF FLORIDA
COUNTY OF 'rot: COUNTY OF
The forgoing instr ent wa acknowledged before I I The forgoing instru ent wa cknowledg5d beforF
�,.,".,
this day of 20/4 by X�� this�day of 20/& by
2 M� e;
�,mgt�.t�&T G-MA
(Name of person acknowledging) a mT= (Name of person acknowledging) �g c
n Nv m� 2 52
co�< �<
N W m
z C
(Signature oirrAotary Public-State of lorida) ( ignature of otary Public-State of Florida =�T=
f'np ONV S
Personally Known ! OR Produced Identification Personally Known -'o" OR Produced Identifi
Type of Identification Type of Identification
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
ev.7/2014