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All APPLICABLE MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: LollI&I-I PerrmitNumber:
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: 4C
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Legal Description: c �n'1. Lc,- �OcNdev%5 d� AJC 1Ap 'P, )k
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Property Tax ID#: ��ly �rJZ�) teal' -- X50 •ted
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
IAC Cue -t l�.e �� �C.e. - C�tx�dm�n �. s -�� � lLo 5eeAr
ulndeu,se✓ - ('CSX,l t���. Aiv- hxan . ev' — 45V�cl b 1'4A-
UCTION INFORMATION:
clitional won to o performedunder-this permit - chec
k,Mechanical _ Gas Tank _ Gas Piping
Electric _ Plumbing _ Sprinklers
appy_
Shutters
Generator
Windows/Doors
Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
as
Cost of Construction: $ (� `� r Utilities: _ Sewer Septic Building Height:
QWNER/LESSEE �. CONTRACTOR':
-L t
Name l� J I-. L..0 1./ Qi[ /�i Q n 0.Uhe6
Address: -7 "F 15 ,5► LV pN �-Dr Company: �! l,o4
City: k-'-Lcj c— State: FI. Address: P -D: PJ�g Azb 7
Zip Code: ALM5; - Fax: M II A, City: (� ?Sew -&e__ State:
Phone No. 6t, i 6LI D, ' 6b1, Zip Code: SLLISL4 Fax(M) kb- 42 1)
E -Mail: al A- Phone No as • 33� t
Fill in fee simple Title Holder on next page { if different E -Mail,-- s t✓Ot� i�. . Cb tYi
from the Owner listed above) State or County License (� I� I�05-7
SLz :tj�- RLPt4 ILA
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNE
Name:
Address:
City:
Zip:
ENGINEER:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
--' Not Applicable
State:
l"Not Applicable
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
✓Not Applicable
State:
-`N-ot Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
commencin.&,w0kler recording your Notice of Commencement. ,
'ture of Owner/ Lessee/Agent 'fure of Contractor/License Holder
STATE OF FLO IDA _ STATE OF FLORIDA
COUNTY OF , , �.I�.c.• a COUNTY OF
The forgoing instrument was acknowledged before me
this i U day of 2017 by
eir
(Name of person acknowledging)
(Sig to f try I' - to of Flo'
,n►13 'l l�I�i I �
Personally Known � OR Proc!4' ��
Type of Identification ?Q
Produced
Commission No.F 161S3371.
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE -
RECEIVED
DATE
COMPLETED
rev. 7/2014
AFF '19`�33�
The forgoing instrument was acknowledged before me
this (d day of 7s_..� , 20n by
(Name of person acknowledging )
{Signature of Notary Public - to of Floricira��NA L Q(qC 4>,
SABRINIA L. BLA �xSP�"°��sloN'`•:t
Personally Known w"" OR Produce IcIc ii ,c iYarrn
Type of Identification _ 9 Lo ;
Produced
rrGa " FF 195337 'o
Commission No. F�F i 1S �✓� 1� "� nded �;: o`
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW