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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: )0 . IcS. Permit Number: r"))) tc�� V - 0 0-t)
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_ Building Permit Application OCT 04
Planning and Development Services 218
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Reitleinitigie Xunty, FL
PERMIT APPLICATION FOR: fl_
PR®POSE//D��-INIPR®VEME 1L®CA g. o d4° . r 1 . -d ,,A .', ,i-v°1/4-
Address: ((l.OQ t \ & W ..-D\--\--see...-\-- �-t r\)(431 34QA Co
it
Legal Description:
Property Tax ID#: 1 42-$-- fl C)?"" O 503-OOb-R Lot No._
Site Plan Name: Block No. ''
Project Name: �^
Setbacks Front Back: J' Right Side: J ( Left Side: ,
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DETA(1 J DESS ° 'PTI® WK° m� ,�
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SIR CTI®N IF®RMATI®N '1:':' ' i e';y. . , ,;, p , v.
Additional work to be performed under this permit-check all that apply: 11 .d
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: ZOO a Sq. Ft.of First Floor:.'._
Cost of Construction: $ 2-Ue:9c2 Utilities: _Sewer _Septic Building Height: '
II
OWNER/LE�S�SEE°. . .:0', 1 ,., a, ,CON °ACTOR° r :i 1 %;; .
I
1.
Name ...)(1.S3-% yert Z Name: I,
Address: c:WAQq as 01 Cee.-A- Company: ,'
City: 1R(2_--\.- pi Q e C C State:FL Address:
Zip Code:3C/ r y 6 Fax: City: State:
Phone .. '5C0. 3‘.381 Zip Code: Fax:
E-Mai : er 'Z 10t. . g' tai/. I Phone No
Fill in fee simple Tit e Hol•er on next page if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEM CQNSTR`UCTI?N M RAVINF®RMAT ®N
r
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
commencin: work or recordin: our Notice of_,.u. ,,Incement.
. 4gn"..5-,---- ,.9,44=-'...C°.?
Signature of Owner/Lessee/Contractor as Agent for Of le?"''" . ;Signature of Contractor/License Holder
STATE OF FLORID a Xoa STATE OF FLORIDA
COUNTY OFge_e_i
2 m�3 COUNTY OF
.2 .o 'Theforgoing instrument was acknowledge efore m: - a The forgoing instrument was acknowledged before me
this day of - ,20/Yby ;;;;1' !this day of , 20 by
l - Cv
ciNy�
CI.cCD t� - a �_
Name of person making statement. , . , Name of person making statement.
Personally Kn.wn, OR Produced Identification / Personally Known OR Produced Identification
Type of Identificati . Q%- Type of Identification
Produced &{ '‘ e4 L• Produced _
Air
(Signature of Nota 4 blic-State of Florida ' I (Signature of Notary Public-State of Florida )
Commission No. , (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING. SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER - REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17