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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` 0�1�w�
Date: JO - 8 -/ U Permit Number: r 1 Q' 0 -irlin i
'C'IlDLI IN T .,� RECEIVED
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Building Permit Application OCT 0 8 mg
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)4624553 Fax: (772)462-1578 Commercial Residential . 1
PERMIT APPLICATION FOR:
PROP®SEI!IN RDV EM LOCATI® d:;v p '.v off., ' a r: �n 7';-,-.Te ,ft-- ,
Address: :172 Se S 7 'J? � pi ,e ec-F C Glp lj i l 6'L1�f�r 2)
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Legal Description: . /41/024 ✓/GLA �/9/2D EA✓J S/....1) - PA/if 7-11/2 r kJ /.Sr.r
C 8qD F% 0f .i r/Z8. sy y- tar Rio (D,e 32 23 —%/ 151)
Property Tax ID#: 2 '127-601– 005-7- D /D - 9 Lot No. -
Site Plan Name: Block No.
Project Name:
Setbacks, Front Back:_ Right Side: Left Side:
A1LED DE- CR PTI®N WORK , r : '-'41 '6, "'
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters VWindows/Doors
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Electric —Plumbing _Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
bV
Cost of Construction:
$ 2 3 O 0 Utilities: Sewer e tic BuildingHeight:
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OW 'ER/LE=�S�SEEa t , -,. €.® ,.RSA OR �' a �;'.`:� gi a :
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Name.„Pt/./) G2- GA/25 At- .fL4 1.-Z-6-
Name: . 5/k7 L7-", .77.iit/Gd
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Address: ZO) NG✓ 2>,�A10di✓A Ate--a"�h/4 if Company: L w71L6---#/'ILiCs LSC.- i
City: ,,7g3 Aq-t/4' State: F - �
� Address: /. 2 J/� !-//i�IG��J/a G�/4'IL/
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Zip Code: .3 '/G Sr7Fax: - ..--. City: D/t-7" ✓r- W C E State: 4-
Phone No. .:03/ - ,NS— 7 '8o Zip Code: 2(-1 9-3 Fax:
E-Mail: Phone No :77/ - 92_y-- 6 Y4w
Fillin fee.simple Title Holder on next page(if different E-Mail f�•••1Gd E 67ei7 /1°4.i'cgrf. 4/ 1
from the.Owner listed above) State or County License C/ZG/a Z 9 ly 9 /
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
UP .EMS] .CcNST p° CTIONI 9 [ag I FORMATI®Ng 4 °e .-4,'.,,,,i-...:A, ::
DESIGNER/ENGINEER: VNot Applicable MORTGAGE COMPANY: iNot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone: ..--
FEE SIMPLE TITLE HOLDER: L7Not Applicable BONDING COMPANY: V Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made toobtain 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 your Notice of Commencement.
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Sign Own lessee/Contractor as Agent for Owner Signaturer7ntrac •r icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 54- Lue....sk COUNTY OF S4- LJc-cr
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this ((day of O-1 . , 20 )rby this.forgoing
of 6CJ ,20 My
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Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification TType of Identification
Produced 0(......, Produced DL
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(Signa urery Public- ate of Florida . (Signature of Notary Public-Stat f Florida) U
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Commission No. (Se.' �a m Commission No. (Seal Oma M.t'�
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DATE =coves COMPLETED `� `'1111`,,'
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