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a ALLAPPLICABLE:INFO MUST BE COMPLETED FOR-APPLICATION:TO BE ACCEPTED :.
-Date: 3. :I . . . . . Permit-Number:-- ( -
------ - - Buildiing Permit_AppliCationECS
Planning and Development Services
Building.grid Code'Regulation Division, MAR .f 3. 2017. .
2300 Virginia Avenue,-FortPierce FL 34982
Phone:_(772).4624553 Fax:.(772).4621578 _ Commercia1. Residential >
PERM:IT.APP:LICATI0 WFOR:. To SelOct:from dropbox,:click arrow-at:the end of line ,--
PROPOSED:IMPROVEMENT
ine -
P.ROPOSED=IMPROVEMENT LOCATION:.
Address:: -fib
. . . . . . . . . . . . . . . . .
Legal.Description:. . .
Property Tax-ID#: l Lo#No..
:Site Plan Name: Block No.
as :PmJect:Name:"Tc l:(: ��f1 e S :-I<Yl.o�i�� -�o M:,,
Setbacks Front Back: . . Right Side:- .. . . . . . -Left Side:
DETAILED,.DESCRIPTION OF WORK:'. . .. . . . . : : . . .
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4.
CEONSTRUCTIOWINFORMATI.ON: -
Additional wor to: leAel orme :under this.permit:-check a apply.
HVAC . LJ Gas Tank Gas Piping =Shutters a Windows/Doors. . .
Electric Plumbing Sprinklers - Generator- Roof Roof pitch
Total'Sq. Ft of Construction: I 15A S _1�. S Ft.of First Floor.
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Cost of Construction:-$-o2 4 5. Utilities: Sewer. Septic Building Height:
. . . . . . . — .
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OWNER/LESSEE: CONTRACTOR:
Name X-f. bPA:�U oL 4J2 Lnc Name:
Address: 31: 0r. Company:: i V1.5t. A &_&U
State:FL Address:
Zip.Code:. y- . . Faz: City: rte: State: �L
Phone No. 7�70�.— (n 1.a-�-1 Zi' Code;
�' ( p � Fax:
E=Mail: .(I OIn�-.S -Ccc Phone:W.. "7:70? '.S.Iq
Fill:in fee simple Title Holder on next page of different ::'E-Mail: (�4L+C P C( C V� y Guk_6 0:, Lem.
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from the Owner-listed:above).- State or County License: CC-ic 6 6 a-,5
If value'of construction is$2500 or more,:a RECORDED Notice of Commencement is.required.:
SUPPLEMENTAL CONSTRUCTION:LIEN LAW INFORMATION:
DESIGNER/ENGINEER! Not Applicable. MORTGA. ..COMPANY;." : : _:Not.Applicable.
-Name-
-Name:
Address . Address:
-City: State: City: State:.
:Zip:.. Phone: .Zip: :Phone:.
-
:-FEE SIMPLE TITLE:HOLDER: :. _Not:Applicable. � BONDING COMPANY: Not-Applicabie:
Name: Name:. .
Address:: Address:
City:: City:
Zip.. Phone: Zip: Phone:
certify that no.work orinstallation has.commenced prior to the issuance of a permit..
St:-Lucie:Countymakes no representation that granting a permit will authoriie:the'permit holder to build:the subject structure
Which is-in-conict 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.-
:Inconsideration.of-the granting of.this requested permit,-.1 do:hereby agreethat 1.will,imall-respects,perform the.work.
in accordance with the approved plans the Florida.Building Codes and St.Lucie-County Arriendrrients,
"The following building permit applications are:exemptfrom undergoirig a full concurrency-review:"room additions,
accessory.structures,swimming:pools,fences,walls;-signs,acreen rooms_and accessory uses to another non-residential use-
WARNING TO OWNER:Your:failure to Record a Notice of:Commencement-mayresult'in your paying-twice for
improvements to your:property.A Notice-of Commencement must:be recorded and-posted:ori the jobsite
before the first inspection:-If you intend to obtain financing,consult with.lende.r:ora n:attorney_before
.-,commencing-work or.recording: our.Notice._of Commenceme
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature.of Co tr !tor/License Holder.
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9 STATE OF-FLORIDA. : STATE OF FLORIDA:• .
COUNTY
ti�c.r.e COUNTYOF t- L-Uy(C
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The fooing instrument was acknowledged before me The forgoing instrument was cknowleiiged before me
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this 3 da of �c)`. . .
y 20.1` bq this day of LU Gt-t i✓�l 20' 1 9. by . . .
-(Name of person acknowledging) :(Name oferson-acknowled 'in
P g g). :"
• Via. . . . . , . .. . . �t701-�
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(Sig a rere-of Notary Public-State of.Florida -(SigQure of Notary Public-State of Florida)
Personally.Known OR Pro_duced.11entification. Personally Known :r� . :OR Produced Identification=
Type of Identification Produced FL. r,veers. L«e, "Type of Identification Produced
Commission No: Ca 6, d.30S Commission Igo.6C U"3fft AQ
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=LIBET117ANN ��o%kol Pte�� ELIZABETH AN ALVARADO
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ELIZABETHtALVA
A00 ?. o,. Notary Public,State of Florida
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: : '•. e or dacommission#.GG 030544
N� CommissIon N GG 030544 . ' '9 �:�.M Comm.Ex
Revised 07/15/2014 '�F My Comm.. �. ';F,�F F�o;:� y pins Oct 20.202
tFid;;: Ex ices Oct ,�,;�„��
•,n,n,,, P. 20,2020
Sonde : tirough National Notary Assn
Bonded t.
REVIEWS'. FRONT. ZONING SUPERVISOR. .P S. VEGETATION SEA TURTLE MANGROVE
:COUNTER. . REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
DATE .
COMPLETE
INITIALS. ..