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All APPLICABLE INFO MUST BE-COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
!hone: (772)462-1553 Fax: (772)462-1578 commercial Residential
PERMIT APPLICATION FOR:
Address: 3nZ �a �� Vr G"- -�
Lelgal Description:
Property Tax ID#: 1II&S (onj -poocl ' coon Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right,Side: Left Side:
y I'ekj//
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Additional wor 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:
'i ost of Construction:$ Utilities: —Sewer _Septic Building Height:
Name !I i`�'-`� /1/(,e!'l`r° 14
Name:
Address: s3S o.�dfti ,��aG�- Company:i4= rMS Ne•?c� r� L e-C
City:1/'� Q e-.Lc-4 State:��- Address: /, .
Zip Code: 3-olc� Fax: 9?x—`191—,20'31 City-11cry 13r -4 State: �L
Phone No.,7� - `�9- Zip Code: 3�-`� 2., Fax: 99d--995-R03
E-Mail: /'�5���`10E r2 �adiarn, c-:'e" Phone No 99a
Fill in fee simple Title Holder on next page(if different E-Mail c Lq/�7
from the Owner listed'above) State or County License E�9�
i If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
_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..
Signa a of Owner/Lessee/Contractor as Agent for Owner Signature ontractor/License Holder
STATE OF FLORIDA \ STATE OF FLORIDA `
COUNTY OF COUNTY OFLV�L�;"g
The forgoing instr;,&Ment was acknowledged before me The.forgoing ins ment was acknowledged before me
thi ,Lo day of 20_ by thiszL�day,of 2(1% by
AkkN
(Name of persona nowledging) (Name of person AknoWedging)
fjn� - A�Q
',Ili ature o Notary Publi State of Florida) Qn ure of Notary Public-St a of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification.._ Type of Identification
Produced Produced
_ %M,,,, AbnAhi A INGRAM
Commission No. . LASHAF'($� R Commission No: "° ¢`�
IN Public-�j�tQo 9 Florida
Notary Public
State a of Florida F ¢ m.Expireb`D2�20,2018
Av comm.Expires Dec 20,2018 7 ;,f F`S,: Commission f#FF 177299
Commission
REVIEWS c4,, '� B nis{�7NOp�1�R�ation I ► ° OR PLANS VEGETATION SEA TURTLE MANGROVE
GO.I�NTEfREVIS-E REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014