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ALL APPLICABLE INFO M USTIBE COMPLETED FOR APPLICATION TO BE ACCEPTED 11
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Date: - 5- `-9 Permit Number x'1.0'3 v 5'5 '
RECEIVED
o .— x. °per .-1 MAR 2 5 1018
Building Permit Application permitting Dopertment
Planning and Development Services St. Lucle County Ii
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Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 v
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: {g 4 10 WI DS 01•i %N1��
Legal Description: I O Il 1 O" R)f v114 \--3(:).v) oo ¶G/)- /1 v rL,
te
Property Tax ID#: G 9n, ^ _ • 5" l 0 6. Lot No. I if
Site Plan Name: Block No.
Project Name: 1,
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
N)1qCRivheAA 1 Of 50 8.1 I et,eckr-it. Luak-P- kta-1-2-e .
CONSTRUCTION INFORMATION:
Additional work tobe erformed under this permit—check all h appy:
T1 HVAC 11 Gas Tank nGas Piping _Shutters Q Windows/Doors
I 1 Electric W_I Plumbing [i Sprinklers _Generator Il Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ 110, -.5 Utilities: Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
JName 44\11)42.4\n ,k�� Name: . �NyCil . ✓j'eth0�
Address: pb.2ZTOMOS oi POIITT
12c. Company: .Roe.( -c_
City: PS L ;i State: Ft Address: ,1 ,CI iJ� *D11,9 �'E
c�
Zip Code: 3 c)O G j Fax: City: P,S1, State: -
Phone No.95 'to- .L 51-i Zip Code: 3 ti`7 FFax: ii
E-Mail: Phone No. —7701----177-670/J 1'
Fill in fee simple Title Holder on next page(if different E-Mail: 64-l'Cc L3 O Woo-w04.
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from the Owner listed above) State or County License: c (414,2 ue y
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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.
Signature of 911vner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA,�'
COUNTY OF��=
The f r oing instr nt was acknowledged before me
thi� da f Ll ' 20 by
Name of person ing statement
Personally Known OR Produced Identification
Type of Identification-
Produced
dentificatio..Produced
ry Pu
Commission No.
`MihmissbnI GG101442
IseDplft May 4, 2021
Bonded thrn Aaron Notary
Signaturontractor/License Holder
STATE Of F FLORIDA Ile
COUNTYOF
The forgoing instr m nt was knowledg d before me
this ''-day o, 20 by
Name of person ma ng statement
Personally Known "" OR Produced Identification
Type of Identification
Produced
of Notary Publi
Commission No.
GWIl ion IIt GG101442
May 4, 2021
Banded N Aaron Notary
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Rev. 8/2/17