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ALL APPL11C ' L COMPLETED FOR APPLICATION TO BE ACCEPTED
A.- E INFO M4ST BE
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Date, Permit Number; � , •
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C��.�rpt � �►��'�."' rte.
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Plahning r e Development -
Building r deRegulationDivision
11 Virgin Avenue,
Phone: 462-1553 Fax-, (772)462-1579 commilircial Residential
6 oil 01 0 MAN
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Itio 0 erfioWod under this permit check all thA apply:
HV
1 Piping
Plumbing '[]Sprinklers • Roof
Tota I Sq.Ft of onstruction: S Ft of First Floor:
i . . i r ewer[jSeptic Building
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Zip Code;21%
Phone No.Fill In fee slmp�
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DESIGNER-YE Glii4EER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State; City: State:
Zip: Phone: Zip' Phone:
FEE SIMPLE !TLE HOLDER- _Not Applicable BONDING COMPANY: —Not Applicable
Name: Name:
Address: i Address:
CItY. City-
Zip:
ity:ZIp Phone: Zip: _ Phone: ;
•certify that n work or installation has commenced prior to the Issuance of a permit.
St.Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con ct
m with any applicable Nome Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Pleas consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideratiot of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance th the approved plans,the Florida Building Codes and St.Lucie County Amendments,
The following b ilding permit applications are exempt from undergoing a full concurrency review:room additions,
accessory struc ires,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING T . OWNER., failure to Record a Notice of Commencement may result In your paying twice for
imp ovemen s to your property,A Notice of Commence ent must be recorded and posted on the jobsite
bef a the fit t inspection. If you `mend to obtain financ'r ,consult wit lender or an attorney before
com encin din r Rlotice of Comment . ent.
Signat re �U�
of e s ee Sig urea Co ra ce se Hold
STAT OFF f� STA E QF 02
1:4
0 COU of -
The forgoing in trument was acknowledged before me The forgoing instrument was acknowledged before me
this,„day o 1 20?by this day of 20_ y
Mr\.A. L?A(1 , Q,,,�NdILY I-I/I
- !�:f '
Name of pens acknowied l } (Name of pars n cknowledging)
gnature tary Public-st' of Florida} gnature of NoJA Public-Stato-of Florida
Personally K ri,, o Personally Know '+nQR ProdM&w966691LcLn ;
Type of Iden * h 4ucedJFRALYNNE RUSE r r Type of Idenfitflta irid� rid
Notary Public-&t8ta of FiDWEI ° * Exggf��res Jul 22,2017
Commission x r�i6@�1 2,2Qt7 Commission No. C a4}6 036892
"'ail�u' mmissioq�`Fi:08839a •J'+++•un"`
Revised 071 5/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
1