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ACCEPTED
E Number:
Date: em
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Building Permit Application AUG 0 2
Planning and Development Services PERMITTiNG
Building and Code Regulation Division St. Lucie County, FL
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
PRQP.OSED=IMPROVEMENT LO"CN:
Address: /a 01yu Jr' OC67W 7n (001 , Timc& / &ncd, ayelOr¢
Legal Description:_�56AW1 nl a 0"00 &?1- &!D77 �D/Z t'O , 987yci
i0o�-ay3
Property Tax ID#: gSo Z-goy- 9047 �G�"� Lot No.
Site Plan Name: Yyte,Q4,((of< / A- 19 4 Block No.
Project Name: YG(iZ/>A'/G(IL
Setbacks Front Ala Back: N Right Side: Left Side:
DETAILED DESCRIPTION"OF VICORK
J04MV4 6UA/N69, s &09 AW4�7S
CONSTRUCTION INFORMATION
Additional work toe e Orme under this permit-check a appy:
❑HVAC Ei Gas Tank []Gas Piping in _Shutters Windows/Doors
—
11
Electric ❑Plumbing Sprinklers ❑Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 185-0 Utilities: Sewer Septic Building Height:
_
CONTRA
OWNER/LESSEE _` ' =f CTOR
� .
.. . . __ .F.,_ a. .,.. .._ '.. �. ..._
Name 2 A-"L- "Oczn4A, Name: IC-q*r2 &C00VJrJ
Addre g Company: &-NStW L-A•-r tk Lt A4 14,144
City: C IT Stater Address: (72J A(W '�.YI,4--
Zip Code: 3 Ll gi9 6 Fax: City: CYq z State: P
Phone No. '11Z_ S bR r Zip Code: :?499'y Fax: (o9 Z—g1'IyL/
E-Mail: Phone No. 112- 2 -•bort
Fill in fee simple Title Holder on next page(if different E-Mail: 0
from the Owner listed above) State or County License:��j����
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMI✓NfiAL3CQNSTRUCTIQN LIEN LAIN INEOR(11iAT10NF
DESIGNER ENGINEER: Not Applicable pplicable 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: "
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 thepermit 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 fa' re R cord a Notice of Commencement may result' you paying twice for
improvements to/youroe A oce of Commencement must be recor ed nd p ted on thejobsite
before first inu 'n nd to obtain financing, c s It th I d or attorney before
com enc'n or o Notice of Commence nt.
s
gnature of Owner/L e Agent ture of Contrac or license Holder
STATE OF FLORIDA STATE OF FLORI A
COUNTY OF__`�-jam /'�1� COUNTY OF -r
The forggo,yy'n�g instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi�� ay of � 2016 by thi;f v`—y of .i UGy 201,6 by
(Name of person acknowledging) (Name of person acknowledging)
(Signa f Notary Public-State—of Florida) (Signat otary P/lic-State of Florida)
Personally Known OR Produced Identification Personally Known `' OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. -- z Commission No.
ANN M.GAUMOND1�..... ANN M.GAUMOND
I�4' A.
: MY COMMISSION#FF 173907
MY COMh415SI0N#FF 173907
Bonded Thrti No Public UnLyriters o F°p' Bonded Thru Notary PublicUndenvrters
Revised 07/15/201 '=
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS