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Building and Code Regulation. Division
2300 Virginia AvenueA Fort Pierce FL 34ya4c Co mercial Resident*lal
Phone: (772 ) 462dm1553 Fax.e. (772 ) 462,*1578
PERMIT APPLICATION FOR@*
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I Holder on ne*t page if F'Is I I 'I'n e s I pie T*tle
diE-Mail :
fro the Owner flisted above,) State or County License :
If VajUe of construction is $2500 or ore,, a i RECORDEDNotice of Co mencemrequired .
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DESIGNER/ENGINEER : , Not Applicable MORTGAGE COMPANY : Not Applicable
Name ,, Name :
Address : Address :
City : Sta te : City : State :
Zi p : Phone : Zip : Pho ne :
FEE SIMPLE TITLE HOLDER : Not Applicable BONDING COMPANY, Not Applicable
Name .. Name*.
Address -, Address :
City : City:
Zip : Phone : z 1P # Phone :
I certify that no work orinstallation 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 wit 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-wre-sidential 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
commencln work or recordilng., our Notice of Commencement ,
ature of Owner/Lessee/Contractor as Agent for Owner Si ure of Contractor/License Holder
S E OF COUNTY OFFLORIDA
��. _ � �� � � ;� COUNTY OF �,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this _,� day of 20 �by this day of i 20 � b y
(Name of person acknowledging ) ( Name of person acknowledging )
(Signature of Notary Public- State of Florida ) (Signature of Notary Public- tote of Florida ) '
Personally Known � OR Produced Identification Personally Known _�� OR Produced Identification
Type of Identificat' Type of IdentificatioOF& I Z
PUM ' '
�Norn• a� CHRISIINE
�1�A•.. EPPER .�, z CHRISTINE CULPEPPER
Commission No . ': COMMIS GG 061780 Commission No . MYCOMMI � �kfG061780
'-: ;o;� EXPIRES: January I 1 , 2021Q�' EXPIRES: January 11 , 2021
1� •• •4 �q Undwmftn
�W �1�1I NOt81y �jG
AL 3bw NO�V ;hftlkwenwiks
NOW
Revised 07 52014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW' REVIEW REVIEW REVIEW
DATE
COMPLETE - ------- --
INITIALS