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All APPLICABLE OFOM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: t��___/
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)46271553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PREP®SED INPROUf(UIENI'L.®CA�'IQI: .
Ad tlr`esr s �q f ��F� �no P� /� R ➢fQ2 C- z 11�' ��
Legal Description:
PropertywT.ax:IDR# 2`{�21 - 7p _ o Lot No.
Site Plan Name: J Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILS® DESCRIPTION OF V1/4RK:
NMI
h oi�1 -� a
CONS`fRl1CTION INF®RMAl"1®N:
it11111 IN K"
ional work to be performed under this permit–check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/ oors
Electric _Plumbing _Sprinklers _Generator C:=R:&f=' l itcf
Total-5 r_'uction �J Sq. Ft. of First Floor:
wCost=of=Construction:-$ 2 3 Utilities: —Sewer _Septic Building Height:
OUVNER/LESSEE:, CONTRACTOR:
amen== I K G-f Name:
Ldress: :2q lA Sher wobA Company:
City: 17 I moa— State: F_L Address:
Zip Code: 3—'/+7kL' Fax: City: State:
Phone No. 7 Z – Z ✓ Zip Code: Fax:
[Mail: f� 0 a( Com
Phone No
E
Fill in_fee•simple Title Holder next page if different , E-Mail
rom the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU+PPLEi1lIENl"RL GONSTRdl1CTlON LIEN l�UI/ I!NF®RIUI�►TIO'N:
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:
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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIGA STATE OF FLORIDA
COUNTY OFCOUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of J i l., 20 1-
by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
2 0'JL � AzL_� -
(Signature of t Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced CATHYJROBERTS Produced
Notary Public-State of Florida
Commission No. FE C&Aslon#FF 221708 Commission No. (Seal)
�$"��,�?;� My Comm.Expires May 10,2019
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WING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
RE`: ' �O NSblic-Sta �q�
* CCIPbtdhhj�s in F � a : REVIEW REVIEW REVIEW REVIEW REVIEW
DA E m Expires May 27,2019
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R E RW"r"Assn.
DATE
COMPLETED
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