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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11-Al-ko Permit Number: t 04-
•
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: To Select from dropbox, click arrow at the end of line
PR;O
P IIVI 'ROVEMENT
OSED LOCATIO'Ny`
yyi
Address: 505 ki f-h S+ F4" Pie rco EL
Legal Description: $3`J r'I I=ro✓Yl ►��. �� 0 -F NLS �� 0 /J (JJ�� 12 U j'1
S 8.50 •P+ Th 0 /� W%1-f-F IJ SeCG L. (�D �-f- 0 f' PO b
Property Tax ID#: aY;-108 a a a r� �0 - ® 0 0 - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�,� Y s S 1� q l
1 1
DETAILED DES.'CRIPTION OF WORK �
kep(aG ng 1 a w i not o Ws af�cl ne W e)ckx-;. r d6 ors.
CONSTRUCTION"INFORMATIORI
Additional work toe e orme under this permit-c ec a appy:
HVAC 11GasTank F_]Gas Piping _Shutters ✓ Windows/Doors
Electric 0 Plumbing Sprinklers E]Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
0-0
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name A+-1 anh C_ COaS+' TrOLA 5,porf !Name: kOn rr �`- 5 on s ..1_ne.
Address:31a0 Ro !1 P"s Rol Company: 10(4 S, 1) Xv^(!!.
city: �'orl- P,erci P(_ State: fR- Address:P+ Sl' �-u e'ie,
Zip Code: 54 a 9 I Fax: City: Tl-I S f L-u C e, State: r-L
Phone No. 7 7A-519- 0 0 4 A Zip Code: 3 Lf C1 5 3 Fax: �37�-171
E-Mail: Phone No.(_7701) ' $7 q,-Q 10
Fill in fee simple Title Holder on next page(if different E-Mail: r In Gt.r r�4 1 n 1 tfL/Q h Co. CO M
from the Owner listed above) State or County License: C 0 5 9 7(2 (o
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
�SUPPLEiVIENTAL CONSTRUCTION LIEN LAW INFORM,4TIONNjai,:y
DESIGNER/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: 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 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 recording our Notice of Commencement.
Ix &�i_ Haj_�'w ,, )�34 6LL22gs
Signature of Owner/Lessee/Conor as Agent for Owner Signature of Contr ctor/License H er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 1�0_�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisr day of Nb\) 20 lL-by this�day of 1�V 20 t�o by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State bf Florida) (Signature of Notary Public-S to of Florida)
Personally Known OR Produced Identifications Personally Known OR Produced Identification I
T of Identification Produced Type of Identification Produced
l���DO•^13'a.s�•aS5•p �. .�
Commission No. (Seal) mmi
LAion No. (Seal)
- � SHAHNA ING A
State of Florida.
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Revised 07/15/2014 `2• My Comm•Expues AM
FF 179249 LASHAHNA INGIt
Assn. Y°"
•�� Commission ay°�y� °��, Notary.Public State of Florida
al Notary
through Nation. ,•.��,_My Comm.Expires Dec 26,2018'
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REVIEWS FRONT Z& ` SUPERVISOR PLANS VEGETATI °�,lS�'TUi4TEt 'V
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
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INITIALS