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ALL APPLICAB,LLEr INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� O Permit Number:
•I
RECEIVE® �.
Building Permit Application OCT 1'7 2016
Planning and Development Services i
Building and Code Regulation Division
2300 irrginia 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 =:
Address: O C �lI �,�✓ La % 13.3
Legal Description: W I'701niC.L V/CC��,2 B� //�Z S CM Ae�/n7 vel 6/9-1
Un/T 13 3 t /pro 124 r/1 5NA"'9E .zii Lo-'?7'no c./ (OR 3"0-26 LD
Property Tax ID#: 415-11 - Fr/o — 0 / 4,10 0o® - Lot No. 133
Site Plan Name: Block No.
Project Name: i
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Setbacks Front Back: Right Side: Left Side:
10i f1 CF- EK(5 7.10 4 V Pi-52-4C
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Additional work to be Derrormed under this perm -check a appy:
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HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
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®Electric El Plumbing []SprinklersE Generator a Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 7 Q o Utilities. _Sewer E]Septic Building Height:
Name (_�} Name: I EM /1 =R6/M i✓9 Te.
Address: 1 O 0 5-1 S, 005" P>�� �r/33 Company:
City:F_d 5gi) 8A.9--h, State: . Address: 57_', it/l✓ ��fl%<2��/ �l/��.
Zip Code:3y 2.5-7 Fax: City: )&T ST- Lug/ t State:1?9-
Phone No.7 7?- 233" a 5_7� Zip Code•3Y-2g-ro Fax: 777-40>-7'17S—
E-Mail: Phone No.7727-3'10" 74/7
Fill in fee simple Title Holder on next page(if different E-Mail: bw(i LQ,^ a cal-n
from the Owner listed above) State or County License:
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If value of construction is$250D or more,a RECORDED Notice of Commencement is required.
h:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: �( Not Applicable
Name: Name:
Address: Address:
City: State: City: State: r:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 j
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.
J_Ji`
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Signature o Ow /Leg ee Agent Signature of Contractor Lice se'Rolder
STATE OF FLORIDA _ STATE OF FLORIDq
COUNTY OF S/- &X--/`L COUNTY OF 3T 6UC/ F
The for ting instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of pCr2 ilftl' 20 16by thisday of DCl8GS/ 20 f& by
_LL(Name of person a owledging) (Name of person ack ledging)
S" ture of Notary Pu ign elic-State of Florida) Sc Notary Public-State of Florida)
Personally Known 'e /OR Produced Identification Personally Known 'OR Produced Identification
Type of Identification Produced Type of Identification Pr - I.
TO I L WARNER TORI TORI C WARNER
Commission No. f'I'= a� WARNERmmission No. =°• '= MY C&W&SION#FF909394
WIT YoIGl�ISSION#FF9093 4 EXPIRES October 11,2019
'a EXPIRES October 11,2019
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Revised 07/15/2014
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