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) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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___ __.____ _ ____.n_ Building Permit Application Permitting:a 21!18
Planning and Development Services St. Lucie County
Building•and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ke/ ,
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PERMIT APPLICATION FOR:
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Address: 5-9d y a*iv.,-gd P
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Legal Description: cam/,. r r O 9 f9-L r6 L64S. 2 /c-2- -- -�14-'4 /9 r- /Z/rr&-x. t„-',5"r/240-4.,c..
Property Tax ID#: 3y 02- ' 6io D`/c'/ - GG6-- I. . Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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••itlona wor to •e pe' orme. un•ert is permit-c ec' a tbatappy:
_Mechanical _Gas Tank _Gas Piping _Shutters VWindows/Doors
_Electric . _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: _
Cost of Construction:$ t9 D 9- f>1 Utilities: _Sewer _Septic Building Height:
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Name / 0S/i4-1/ t. -A/2-4-n-- Name: k7.z41..-n-i1 Tk,,,
Address: S 7- 3 S-4LAd 9--4i' c, T Company: P. ?ti -'7 1-Zr A e-c-re x/2_7'r-
City: p a/'-r 5-ir-L Id L nv State:P-e-- Address: ?i r N w , /L 1 4l s' 7—
Zi p Code: 3 L/ y e t I Fax: City: n6 n-r Sr- L c. irs State: L-
-Phone No. 7 7 . . ,..a /p I 7 Cr.s— - Zip Code: 3 2 f) Fax:
E-Mail: , Phone No 7 22-- — G Z4 — 3 s'SG _
Fill in fee simple Title Holder on next page(if different E-Mail 6 u i/e/(e-r p1- -/9-g7,-/- 5 mv.-, I. 4-8-7"-
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from the Owner listed above) State or County License G 6- e v?el Z®r
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ) q J 9
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DESIGNER/ENGINEER.: _Not Applicable MORTGAGE COMPANY: _Not Applicable
. Name: , . Name:
Address: ' Address: •
City: State: City: . . State: 1
' 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 your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent • •y li Er Signature of Contractor/License Holder e
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STATE OF FLORIDA I _o� z 4 r
STATE OF FLORID; �,�7_g
. COUNTY OFII' ' ��,J. - _. 6 Z COUNTY OF ( 4#1 • .1.-e-t-e-, i rgz E
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The forgoing instrument was acknowledge¢�efo�-`r g The forzoing instru,jjig�ent was acknowledge f.r z
this 1N.day of (9..Q,'I'- • ,20 O by m this/. day of (�,P� • ,20� d by oQ
`..• ro. Q�x g
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-Dennis el-k. �°t r..• Ph r Li LO `e- 1-ter) t :*.g•.
(Name of person acknowledging) .(Name of person acknowledging) ze. - e• I=; ,
ail
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(Signature of N ry Public-State of Florid (Signature of Notal
ota ublic-State of Florida) •
Personally Known OR Produced Identificatidn Personally Known OR Produced Identification
Type of!dent, c ionn, Type of Ide i . n �n``
Produced �- �r'• ...LAProduced ,� • ice` • fL,•
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Commission No. (Seal) Commission No. • (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE 0
COMPLETED
1ev.7/2014 I0