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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
(9O3O[Date: 3 �j ,t9 Permit Number: `�
RECEIVED
C00,N MAR 0 7 2010
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timisamounim Building Permit Application Department
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
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PERMIT TYPE:ELECTRIC
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Address: 3746 White Way Dairy rd
PropertyTax ID#: 2417-233-0003-000-3
Lot No.
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Site Plan Name: Block No.
Project Name:Douglas
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Install 120V 20AMP dedicated GFCI Circuit
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Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
700.00Cost of Construction:$
Utilities: —Sewer Septic Building Height:
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Name Rebecca Douglas Name:Walter Nasi
Address:3746 Whiteway Dairy Rd Company:Sol ElectricLLC .11
City: Ft. Pierce State: Address:5500 SW 43rd Ter
Zip Code: 34947 Fax: City: Ft. Lauderdale State:FL I'!
Phone No.704-576-3259 Zip Code: 33314 Fax:
E-Mail: Phone No754-423-41054
Fill in fee simple Title Holder on next page(if different E-Mailwnasi72@yahoo.com
from the Owner listed above) State or County License EC1300 8044
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State: ;i
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name: '1
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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. II
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work [I
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
II
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." 1
Signa re of Owner/Lessee/Contract-4f as Agent for Owner S(i4j
re o Contractor/License Holder
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STATE
OF.FL�RIDA I� e '._ STATE OF FLO�13 D �� n n
COUNTY O c � -' COUNTY OF �j /�-(L�
The forgoing instrument was acknowledge before me The for ing instru ent was ak owledge efore me
this 6 day of _ (t f i�4—,20 by this day of d����/T ,20/ by
!' b-e ` o 5 1 14 i1 7457
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification (K Personally KnownOR Produced Identification
Type of Identificat'►- Type of Identi • ation
Produced e---- Produced
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(Signature of - f or�`da*AP) 4.4°'
Si natur: of a :_�' : •.- ..
•try Public State of Florida ( g
f Notary Public State of Florida
� " . KATHRYN PO KER `f' KATHRYN PO+ I
Commission No,M •. " My Commis2. 049422 Commission o. ¢ ply�omm�ss�on G 049422
��,o xpires 11/21/2020 orFlp expires 11/21/2ozo
REVIEWS FRONT , ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19