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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: u QOU-01W
RECEIVED
- bt_
Building Permit Application JUN Of 2016
Planning and Development Services PERMITTING
Building and Code Regulation Division St, Lucie County, Ft-
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PRO!P®SED INPR,OUEMENT L®CATION:
Address: .1613 Yrs SV Sf N /
Legal Description: 0(iArl ��'�/�er /=5�/�re 5 U'o
,II
Property Tax ID#: �4 3TN-to 09,003- COLD Lot No.
Site Plan Name: Block No. /
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE AILED DE�SC �I TI®'N ® WORK:
e ,,el" fr' e26n
CRNSTRUCTIO WNE(JRM TI
Additional worlito epertormed un er t is permit-checkalithat app y:
_Mechanical _Gas Tank _Gas Piping _Shutters !Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: �0 D Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
0ul MROMBE: C®NTRACTOR:
Name�berl- -5a(,6 r' Name: 4rr1.,e A-51L_ /L
Address:l'313 . EQSi, s� . Company: za"5- !0,4,'ah
City: State:_ Address: d,
Zip Code: 3�411MZ. Fax: City: r, Stater
Phone No. 3DS• �1a•I`1C�3 Zip Code: Fax:
E-Mail: Phone No '1`�a- 9�,/� - �So2 10'
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License ati14
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPL RENTAL CONSTRUCTION LIE IKWJIINFO
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 covenantsithat 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.
jS gnature of Owner/Lessee/Contractor as Agent for Owner el 'Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ur � COUNTY OF A1— 1".o
The forgoing instrument was acknowledged before me The forgoing instr ent was acknowledged before me
this_(4)_day of ,20J(0_ by this__6_day of 2%g_ by
orf;4
( me of person acknowledging) (Name of person acknowledging)
ignature of Notary Public-S to of Florida ) gn ture of Notary Publi tate of Florida)
Personally Known OR Produced e ti ' ation. ,_A Personally Known OR Produced Identification
Type of Identificatio LASHAHNA INGRAM Type of Identification
Produced <P"�°"B.''•, blit-State of Florida Produced ,�,��„ LASHAHNA INGRAM
•?_My Comm.Expires Dec 20,2018 , o ��•, Notary Public-State of Florida 18
Commission No. "s"r' 'oc Comm(SY�rBi)# FF 177249 ' -.�* M comm. fs Dec 20,2018
Commission No. i .• Y �l
Bonded through National Notary • o;; Commission#.FF 177249
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��` Bond^d through National Notary As-,n--
REVIEWS
vcREVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ey. 7/2014