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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5Permit Numb r. rte+.. ;Z�k 0" ' t
.� AUG 0 3 2018
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Building Permit Applic t� -ni tirn�� ���r��°tent
Planning and Development Services St. LUCIe QoUnty, FI-
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 lNPR�1/EME M00030007TH
Address: �C�Z c,r.�wc�rp V1b t 1%.4-64-
Legal Description:
Property Tax ID#: \ �.0� ��d Lot No.
Site Plan Name: 1111 Block No.
Project Name:'
'�A�"
Setbacks Front Back: Right Side: Left Side:
D AILED DE�SGRIPTION NF WORK:
;0 it �,
COIU�TRUCTION INFORMATIO
itiona[.work to be pertormed under this permit-check k al. that apply:
'�IVlechanical _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:$ �'O� Utilities: —Sewer —Septic Building Height:
O SER/LE�-SSS � : C�NTR OR:
Name rv'n - Name:
Address: l OZ Company:
City: �"t State: Address:. i C)
Zip Code: Fax: City:� Qi State:
Phone No. `YlZ- Z93 - (0)✓tv Zip Code: Fax:-
E-Mail: Phone No '712' C-11'cw Q_�Z
Fill in fee simple Title Holder on next page(if different E-.Mail 1140&
from the Owner listed above) State or County License_00-6,1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sl1PPl.EI�IENTAi.CaNSTRI}CTI�N I.I�EN lA INFOR+MST OWN: -
j 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 thepermit 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 encement.
Signatureof Owner/Lessee/Contractor as Agent .3ner. Signature of Contractor/Licens Holder ^'
STATE OF FLORIDA a Xag STATE OF FLORIDA, =Jwog
COUNTY OF 2 m�9 COUNTY OF P.li(�A TE
_ar
The rgoing instr ent was acknowledged befor ' The forgoing inst nt was acknowledged beforrj
this�day of 20 by �T 9 this day of 20�'by9
m n Nr
N
(Name of person acknowledging) (Name of person acknowledging)
(Signature(df Notary Public-State of Flori (Signature of N y Public-State of Florida)
Personally K o OR Produced Identification Personally own OR Produced Identification
Type of Identific 'oi, Type of Ienti a on_
Produced Produced
Commission No. (Seal) Commission o. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED.
DATE
COMPLETED
Rev. 7/2014