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All APPLICABL INFO 4UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:AG� Permit Number:,
I
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:.
REP®POSED IN'IR®VEM'ENT LOCATLON:
Address: �— �'
Legal Description:
Property Tax ID #: /---.q,% ����� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Sider Left Side:
I
DETAILED DESCRIPTION OF V1lOR`K: � � � ��
J-4 � � l<D
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CC}NSWUCTION INF ,RiTMATION:
Additional work to be pertormed under this permit— c ec a tat appy:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Windows/Doors
_ Electric _ Plumbing _y Sprinklers _ Generator
Total Sq. Ft of Construction: SQ �7 Sq. Ft. of First Floor:
_ Roof Pitch
Cost of Construction: $ Popp Utilities: _Sewer _Septic
l
Building Height:
OUVN111 /—[-§ �S
C®NTRACTOR:
Name:
Company:
Name Al VIV`
[ �
Address:• f7�.J�/lJ�/fT �vv
City: ��/r ' 7i r? ,, VF State: 7"4_x+
Zip Code: P Fax:
Phone No. L 6-1;?
Address:00
�
City: `fir /� State:i�
Zip Code:, � Fax:
E-Mail:
Phone No '/T 7� //Az
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Sl1PPLE ENTAL CONSTRUCTI®N LIQ LAW I
FOR+M/�TlO,N.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not.Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City:
Zip: Phone:
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
commenc' w_cKk or recording our Notice of Commencement.
Sig atur of Owne Lessee/ ritractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF \� ��
COUNTY'OF
The r ging instruirpent was acknowled before me
The forgoing instrument was acknowledged before me
this day of 201 by
this day of 20_ by
(Name of person ackn ledging)
(Name of person acknowledging)
t ic- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Kn wn OR PPAULAdillid4fftificati
Personally Known OR Produced Identification
Type of Idents i -; Notary Public -State of Florida
Type of Identification
Produced _• ° •' Commission # FF 234730.
Produced
My Comm. Expires May 27, 2019
--'' %° �� % Banded through Natio !ea ry Assn.
Commission o.
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR PLANS
EGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW RE IEW
REVIEW
REVIEW
REVIEW
DATE'
Q
RECEIVED
o�C
DATE
COMPLETED
Rev. 7/2014
i
NTRACTOR
rlLE...467
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ST. LUCIE COUNTY
BUILDING DIVISION
REVIEWED
FOR COMPLI E
REVIEWED
DATE C �
PLA A PERM]
MUST BE KEPT DON OR
NO INSPECTION WILL
------�_�.._____ MADE
�iESE PIJANS AiN0 ALI. E2110P0BUD � ( t
ARE SUBJECT T4 ANY COMECTIt��
R QUi1REU BY FIELD INSPECTORS THS
NIAY BE NECESSARY IN OigD fq TO
CCi ,PLY VI i W A„.L M:1PLFC� BLE: CODES. (� ,
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