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.?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Date: C X. Permit Number:
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
Building Permit Application
Commercial
cMW 7 0 eu -Oo2 /-eW - 9
Back: Right Side:
Aaamonai worK to oe perrormea unaer
Mechanical Gas Tank
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 3 / 40
Residential I%
Left Side:
0�
is permit — check all that apply:
Gas Piping _ Shutters
_ Sprinklers _ Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Name ,A"de�42--)
Address:__�"6& r-yz� `��
City: (117t—M Ad t I O State: O -H
Zip Code: z1a Fax: f
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No.
Block No.
Windows/Doors
Roof
Building Height:
Name: (Urti5 ' cO'aIlmon S
Company: C,us-r,rn A('r 5IStem.0 �>UL
Address: 1( 1S St_ Ti I oq.,,_ n Dr
City: *VOQT ST LuC1� 9f-4,(,
State: rL.
Zip Code: 34 �&L Fax: ' 7,� 335 1 �X
Phone No. 771 33-5 -3 3.2
E -Mail: CuSfigIr- V Qct ("M
State or County License: Cfl C 05 )R /O
If value of construction is 2SKor more, a RECORDED Notice of Commencement is required.
7S-010
It
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State
Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
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 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 recor 7
g your Notice of Commencement.
Signature of Owner/ Agent/ lessee Signature of Contractor%License Holder
STATE OF FLORIDA
COUNTY OF 'y/ �.
The for&oing instrurgent as acknowledged before me
this '/� day of t . 20 /6 by
STATE OF FLORIDA �i
COUNTY OF LjT'
The for oing instrument yeas cknowledgedefore me
this day of (� jSc� 20/& _ b
(Name of person acknowledging) (Name of person acknowledging)
i
(Signature of Notary Public- State of Flo ' a) (Signature of Notary Pu)ic- tate of pKrida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
�,�:-'---�%W CHRISTINE B. ENGLJ LE p�p / / C�1"" "",,/ CHRISTINE B. ENGLISH
Commission No. c� S j� My COMMISSION#EE859 8�ommission No. L 0 / 7 alJy COMMISSION# EE 85928,
EXPIRES: April 4,201
EXPIRES: April 4, 2017
FeF F cP 8andpd TAN pWot Notary Sery 'rF .., P°� Bonded Thru Budget NOhry SCry te,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. //2014