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ALLAPPLICABLE INFO UST B COMPLETED FOR APPLICATION TO BE ACCEPTED
I . '
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce PL 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: T N4`` ---
Legal Description: --Y4k.1� L u C l u�- (Es-bzx 'e S LOt �`?
Property Tax ID#: e . "7[),S -CXZ>;;1_1 C»7 Lot No.
Site Plan Name:_ Q C-%V-e- (-•. Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work toe nertormed under tispermit-check all that appy: .
DHVAC Gas Tank Gas Piping _Shutters Zwindows Doors
❑ p g (�'! !
Electric F]Plumbing ]Sprinklers Generator Roof
— T-ota!Sq. Ft-of Construction: __"-- - Sci.Ft.of First Floor:
Cast of Construction:$ ( 7 Z Utilities: Sewer F�Septic Building Height:
Name 9 Li 7,qfz E-7-W Aim J: s&>zPC-
Address: $d43 �XSw P i ue_ On r Company.Z-F-4.c)
City: 60 y-t- <,t.upState: Address:_1?,�} iQ 75-r-fi 0q:
Zip Code: 3 !J4'�-s Fax: City: L,y, kyti State:_FL-
Phone No.-))a- 34b. C7 7 Zip Code:3SL4 I Q- Fax: 514 �'�V55,CI05
E-Mail: Phone No. 5-bf- 'R -- �(O .p
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGN ERIENGiNEER: Not Applicable MORTGAGE COMPANY: w Not Applicable
Name: Name:
Address: Address:
City: State: City: - State:
T1 p: 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 the-perrnit 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 recording our ice of Commencement.
611-vi,
ute f: -'e -Lessee/,Aje'nt atu of Contractor/License Holder
STATE OF FLORI , STATE OF FLO IDA l
COUNTY OFT@ COUNTY OF '`IQ J
The forgoiDg instrumen was acknowledge efore me The forgoing instru ent was acknowledged before me
this f ci&-Tof ��� , 20 A� this r�day of 1/- 20 /& by
1`I 2_qrl-�- James.D, �U if S
Nam of person acknowledging) (Name of person acknowledging)
e2/_ �
- +_ _ ;r•,
{Signator a offtfary-Public-Stafetbf Florida} (Sign!!y4 of N ary P,ublc-State of Florida
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Personally Known OR Pr uc d inti"ication Personally Known C//OR Produced Identification
Type of identification Type of Identification Produced
SHAT E
RIS RYPu ANGELAYGUNG
Commission No. q0.` pG�G Notary ¢) te of Florida Commi$$ion No.___ 0 P * MY CdB��UN FF 951069
Cammisslon#FF fl4551 Ilk-
res EXPIRES:AprII 12.2020
iVly comm.expires Feb.20,20i6 �1�10 00 ®onded ihru Eudget Notary Services
Revised 07/15/2014
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