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APP111CABLE I FO MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ''�,�� Permit Number:
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- 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:
PROPOSED�IINPR0.1/EMsENT
Address: :5-0 7 .7 / ee /D n 14J
Legal Description: �$�J'_ S
Property Tax ID#: MY 213 00/6) - 000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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C®NSTR'IJ.GTI®N I°N!FORMAT!®;N:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch'
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ /, �00.A�y Utilities: _Sewer —Septic Building Height:
0 . .NERLSSEE C®,NIT
Name J,' ��� �i.`��'il _ _ Name: CiApr PJLr [
Address: iso 7 7 /!d46c� Company: ) mod" 'IL -b
City: /G6 State: Address:_q?4-`7 _
Zip Code: 311�S/ Fax: City: r4 .Pry/[,h State: �7_
Phone No. -77 ; 332 — 0701 Zip Code: '�LI a1 Y 4 Fax:
E-Mail: pl, ('pyr, Phone No -77 ?. - 5-5
Fill in fee simple Title Holder on next page( if different E-Mail /cam e <u ` ' -►IQ he "I, j.[66
from the Owner listed above) State or County License 614L
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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'SUP'P'LEMENl'ALCONSTR+IJCTION LLEN IOW INFORMATION:
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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
commkincing work or recording our Notice of Commencemen
WVe
Signatu a wn r/Lessee/contractor as Agent for owner Sign u of Contra ctor/Lice se Holder
STATE FLORIDA STA E OF FLORIDA
COUNTY OF ,J�. L��r_�c° COU OF ST' LUC K
The forgoing instrument was acknowledged before me The for oing instrument w,as acknowledged before me
thisg/'/1 day of �cT_ 20/) by this day of 204 by
(Name of person acknowledging) (Name of s n acknowledging)
(Signature of Notary Public-State of Florida ) (Si ure dVotary Public-State of Florida )
Personally Known ----"OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificatio .
Produced Produced w*PU State of Florida
Gregory S Kraum
u��Y FiE Pu is State of Florida My commissiq X)2514
Commission No. _ Mschal Commission No. - .max ires 05/19/x%
mission FF 193030
ov 01/26/2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
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