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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rrp
Date: 16 SE 11, 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: .Fc-rRkcAL
"kC}POSED tNE'RQUE
MEN
T LOCATION _ z
Address: 10680 S , OCC-AlU QLVO -4/0-3 TCP0P 6FA-CK 3`(151
Legal Description:
Property Tax ID#: 7 Sr�" �� �' CD/0' 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPT10 C?F WORK ',
QY I S t F C C--- La R Sc'Ew-rS L-L LED CA AJ-C
AJ) DI Anmek A- CZ) Ex iS fikv& 't"r
C(7NSTRUCTION. INFORN[ATION
, s
Additionalworkto be pe
orme under this permit–check all that apply: -
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Q(Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
ODUNERf LESSEE CONTRACTOR _
Name r1i of CC01a, Name: 7UP et-W(M
Address: i OC CA W Cs Company: PP--TAIL- i-iAt•'DY/UA/J
City: �3"F_lu W--ACJ-,l Stater Address: 2Go SW L-UCF.IZO DP
Zip Code: 3Y99 '? Fax: City: Pap--f O–LLk–" (E State:
Fe–
Phone No. ?Ci – Y52--1001 Zip Code: 34 9 93 Fax:
E-Mail: Phone No '7-7Z--?-0Y–&532
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County LicenseES 12001x/30
29696
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
t1PRLE�lI #UTAL CUNSTRI#CTtQN �l N �4W4,N ORMATiON
/ — pp MORTGAGE COMPANY: _Not Applicable
DESIGNER ENGINEER: 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 covenants that may restrict or prohibit such
structure. Please consult with t 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.
ud' '�#' 0 /-/"
Signa Pywnek/Ussee/Contractor as Agent for Owner Si '=OF
ontractor icense Holder
STATE OF FLORIDA TALORIDA
COUNTY OF , o_ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instr Ment was acknowledged before me
this-4-day of 204 by this a—day of 20)a- by
(Name o er )ackn ledging) (Name of p s ckrt, ledging
'gna ure of Notary Public- ate of Florida ) (Signature of Notary Public-Sta of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Ca00- �3�• W - l Zi• O
Commission No. (Seal) Commission No. (Seal)
.,Ii otParn&A(•. LASH ��tpRY;�e LA
REVIEWS FRONT Not r}5 ,� P NS VEGETATION A4 t>RTUbf�ry !Ex ��i
COUNTER , -9 myC m i l a of IorRlg EW REVIEW = ,ilr1R�N Com Florid
DATE yr ''��F�°���'� mission#FF 177 qg " 'o�'`, Bonde m #FF 177P49•,,, �„RECEIVEDBonde through NationalNotar dthroonalNota
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DATE
COMPLETED
ev. /2014