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Date: 7-/ Permit Number:06
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Building Permit Application JUL 2 0 Mu
Planning and Development Services PERM
Building and Code Regulation Division St. Lucie Count , r
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:IM
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Address:�3Jq ,�e,06:s %, 2ehrm � ��R �� 2757
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Legal Description: /%e#leS ds �� .��c- C-290� '.707 : 3YO7 -.�751Y)
Property Tax ID#: y5.02 '.JT-01_15-01 DO9-0Lot No. 13111
Site Plan Name: �e ll/�f Block No.
Project Name: /0
Setbacks Front Back: Right Side: Left Side:
Gd ��efe eh70pion 9h�rerna�G/ 97� S - �.q we
7 r"`" ;" �,==r � . x�> enc a Epi . • +?.'2 y ,- K
ditional work toe e orme under this permit—check a appy:~
HVAC E]Gas Tank ❑Gas Piping _Shutters E]Windows/Doors
nElectric F� Plumbing Sprinklers 0 Generator Roof
Total Sq. Ft of Construction: 6y a Sq. Ft.of First Floor: z0y
Cost of Construction:$ /700,oo Utilities:WSewer El Septic Building Height:
4a^31
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Name 94 vr�l 7n/ S�Jun��i h Name: cm
Address: 5-72 WsLA,`w bn � • Company: , ri;: S... , o f lrc, i`�f•
City: Wks 1` /x:5_ State:� Address: ��%:. 1Y,�:' J)-
Zip Code: 5-3.21V Fax: City: z—fe a seer State: FG•
Phone No. 772" V'80`2000 Zip Code: 3 /95 7 Fax: 772-23z -.2-/9/
E-Mail: Phone No. 77,2 - 2A —37/F
Fill in fee simple Title Holder on next page(if different E-Mail: a" at,m Srn rrf/� i.�G y--'7ioa - coni
from the Owner listed above) State or County License: L"86 /Z 5l r7fl
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 Applicab BONDING COMPANY: Not Applicable
Name: e:
Address: / Addre
City: City:
Zip:. PKone: Zip: hone:
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 o.obtain financing, consult with lender o an attorney before
commencing w r r ordin ice of Commencement.
Sign ur of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLO�IA f STATE OF FLQID
COUNTY OF t'O��m 7 C k COUNTY DF Iia► �`,2G�Ch
The for o'ng instrument was acknowledged before me The for oi. instrrumegt was acknowledged before me
this ay of �L I �t 0 y this� y of J u t 2Q Gy
Arl a rri 1,D rYl 11h 6 d Q M 6/-Y1 i#7
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida-) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identific tion K, Personally Known OR Pro uced Identifiction
Type of IdentificationProduced.Dr !Ve-r-S �(ce r7 Type of Identification Produced r/U2r-s �i de v15 P
Susan Held
Commission No. NOTARYPI(I Commission, men Held (Seal)
STATE OF F=OR DA NOTARY PUBLIC
FF127128 STATE OF FLORIDA
Revised 07/15/2014Expires 8123/2018 Canon#FF127128
Expires 8123/2018-
REVIEWS
!23/2018REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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