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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1, � )�•�'tllt�
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Building Permit application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
I hone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
`PRO.P"O5ED INPROVEMENT LOCATIf3N
Address: 900 Br ��.
Legal Description: t R, W-*- ( 1 `Z.
nD 251 C a//P 3 S
Property Tax ID#: ..3ge2 � (96- a?zil7-O/® Lot No.
Site Plan Name: Ca r Block No. 2-7
Project Name: fr
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK.
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CONSTRtlCTION INFORMATION _
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itiona wor to a per orme under this permit-c ec all tat pp y:
_Mechanical _Gas Tank —,Gas Piping Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total,Sq. Ft of Construction: , 2-71 Sq. Ft. o First Floor:
Cost of Construction:$ 2O�• Utilities: —S wer _Septic Building Height:
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O1IIJNER/LESSEE CON RACTOR
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,Name (°�kJr; � P �' . Came-le Name: n 4.. G ,e_
(Address 7 7 Y/ � J'Jc.," TR,L Compa y: -e' it S '�f �.
!City: We,5+ 'it''"i 132QG�, State:_ Adores : �.3� S: 1 dt4o? (Ziye.v ��'✓�
Zip Code: 33!J/`0 Fax: City: ¢. " / e- State:rL-
;Phone No. ?�lA2� �35�, 70'49 Zip Co c e:Sy?- B Fax: /-Y'99-
E-MailDor- d Cbz Phone o-(-77,20 76D/
(Fill in fee simple Title Holder on next page ifdiffe nt E-Mail-ctecel e
Jrom the Owner listed above) State or County License -6
1tvalue of construction is 2500 or more,a RECORDED Notice of Commenc ment is required.
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5ll,PPLENIENIA CQNSTRUCTION [:1'�E- LA►W INFORMAT110
y - MORTGAGE COMPANY: - ,
DESIGNER/ENGINEER: Not Applicable 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-1 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.
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Sig ure of.Owner/Lessee/CQrVractor as Agent for Owner Signa re of Contractor/Lice/ Holder
STATE OF FLORIDA l STATE OF FLORIDA.
COUNTY OF C . Q COUNTY OF ,
The forgoing instrume was cknowledged before me The forgoing instr ent was acknowledged before me
this�day of 20� by this a day of 20 by
(Name of p on acknowledging) (Name o person acknowledging)
'J,
tc�tuk of Notary Public-State of F da) (Sig ure of Notary Public--State o Florida)
Personally Known OR Produced Identification V Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
.Commission No. _...,_(Seal)`-' Commission NO., � �� '~' `(Se2')
LHS �iNAIN6RAM
LASHAHNA INGRAM }} P State of Florida
State of Florida C� . "Y`O��'' Notary
,.�,R e�;,,,. public 0 2018
niatarY Public' � 1 } ;=o, o= rXnires Nec 2
llMy Comm. :xpires. -.* o.=.My. FF 1
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