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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ?-r ' ' Permit Number:
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Building Permit Application
Planning and Development Services
Building and 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: \'
Address: 4I/frtt Z—
Legal Description:
Property Tax lDTh,1/Zl_?/_/7D t &1z-0 - 01 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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(0) 6?-N3c4tf
CONSTRUCTION INFORMATION:
Addition& work to be performed un.er t is permit - c ec a s. app y:
Li HVAC Gas Tank Gas Piping Shutters El.! Windows/Doors -
Electric El Plumbing El Sprinklers U Generator U Roof
Total Sq. Ft of Construction: S . Ft of First Floor:
Cost of Construction: $ Utilities Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 0,7--f 60-2- 4w' Name: 14- 1/,I4ALC 144(41'Z#'ç
Address:9 'Z'4.44t_Z (.-.,11t1 Company: 7/ (_ /4
City: ~. L State: Address: ZrYa L5
Zip Code: 3$9.f2_ Fax: City: LJ . P I State: FL_
Phone No. 77 * Zip Code: 3c/5
E-Mail: Phone No. 57.,-'33Z-19?
Fill in fee simple Title Holder on next page (if different E-Mail: T ce-7AIL- A-c. -.
from the Owner listed above) State or County License: f 4i?47 4i' -'-f3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTYOF
- Signature of Ownèff Lessee/Agent
STATE OF FLORIDA
COUNTY OF 13 /
S
LOUIS S. GO&IEZ
: (9MMJSSION#FFI1J2
- EXPIRES: May 5, 2019
Bonded TbN Notary Ptábc Underwdteri
Commission No. Commission No.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name:
Not Applicable
Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable BONDING COMPANY:
Name:
Not Applicable
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commence
The forgoing instrument was acknowledged before me
this ? c'day of '74' , 20by
A
The forgoing instrument was acknowledged before me
thisZ' dayof ,20 /( by
# c2vtS
(Name of person acknowledging)
(ToaMj.L1
(Signature of Notary Public- State ofiIorida)
OR Produced Identification
Type of Identifica'iokProduced
Personally Knowr('
Type of Identification"P.r
OR Produced Identification
oduced
Revised 07/15/2014
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS
Personally Know
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(Name of person acknowledging)
(Signature of Notary Public- State of ida