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All APPUCABLE�j 10 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 ,n
Date: / '� Permit Number: / ��
RECEIVED
a
Building Permit Application SEP 2 8 2016
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 Z"'Residential
PERMIT APPLICATION FOR:
PROPOSED IN;PRQUEMNT LOCATLaN. ._. .,
Address: US /aLiY f f S Lucre EL 34J95a
Legal Description: as 3(b 4o ti 1*.3(o �''C oj� N '/R or'FALL—MAT P4a7 w '/a &F Sw`g Of N,-- '/4 )?!-A1G G
OR a3 97ba:Sb -10'i i;17 I -?Aill : 3W4119 38 a _971961 3W -079
Property Tax ID#: / 3,vo - �3� — ���I'�i�L�D- Lot No.
Site Plan Name: &F aLyI fZ �ye l )Q+eCc r�i.I 1'�� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION,OF WORK ;
— - - -
CONSTRUCTIANINFORIVIATIQN }
- ,__ � � a.... is ..., .. ..,n a:: ___;...r t..•. ,___.. _ .>_ ,_., a.e >...
itiona work to!.be pertormed under this permit—check all that appy:
Mechanical N/A Gas Tank A)I_L Gas Pipi Ig A%/A-Shutters N/'A_Windows/Doors
A1/,d Electric AVL Plumbing AJIA Sprinkler'sN//�Generator NZ Roof /llIA Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ (4c;;�. N0 Utili ies: _Sewer _Septic Building Height:
OWNER/LESSEE 3 CONTRACTOR
__.
Name , Name:
Address: '7A� &I �' Il S J1°w 1�, L � Company:
City: .hGr� ,5t ,.tu:.G:i:e State:�L Address:
City: � .' 'I _�fla._ State:
Phone No. VU $06 - 7,515 Zip Code:�3-giL4 `Fax: r
E-Mail: 2rau,k4liEUe)IYeca Fd iyl� 5 Q!Gma, Cdnn Phone No 77 Z 2--0/ 3 7�
Fill in fee simple Title Holder on next page(if different E-Mail
(�G�
from the Owner listed above State or County License C Z
Lvalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRICTION LIEN LAW INFQRMATIQN.
KN R/ � � - pp_ MOR
DEESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Y 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 covenantsthat 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 iyispection. If you intend to obtain financing, consult with lender or an attorney before
commencingWork o reco,4 irh'gy
ou Talo 'ce of Commencement.
�. 4�
5ignatu.e of w er/Lles a/Cont or as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI STATE OF-FLORIDA
COUNTY OF SG, , U Ci a COUNTY OF SA,VII Luc'e_
L
The.forgoing instrument Was!acknowledged before me The forgoing instrument was acknowledged before me
this1a- dayof Selpfevilber 20I( by this�2 dayof SeDlemk( 2016 by
� YA iV1 1 I P.COU�1C/�Z L Gr/' 6/,/1ic>'m S
(Name of person acknowledging) . (Name of person acknowledging)
WQ LIE
(Sign4fure of Notary Public-StpAe of Florida ) (Signat a of Notary Public-State of orida)
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced 47L 1)L--_; Produced TZ r
�4Y°4e�•,, ALFONSO G OROZCO
Commission No. :3';��':�'' L1 Commission No. = Notary P(,�ptate of Florida
ALFOEd �Z725O5
_?( Notary Public-Sta "s Ac My Comm.Expires Nov 21.2017
_U. MM �•. orr��d;•- Commission#FF 72505
f :' Commission AREVIEWS S R PLANS VEGETATION SEATURTLE MANGROVE
COUNTER E REVIEW REVIEW REVIEW REVIEW
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