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I ,All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 \ ` l el Permit Number:1 9 O9 ' v b 7
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:_-__ _____._�. ._LL__ -._..__::..-_-':L-_-) Building Permit Application
Permitting Department
Planning and Development Services ,-t, Luce County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: ', ,hu_kts
PROPOSED INPROVEMENT LOCATION:
Address: ,S.`1Y E or n SS l_,ve 0._ •
Property Tax ID 141 0- 5bQ- D291 I - -9 Lot No.
Project Name:( h u 44K02,3.
DETAILED DESCRIPTION OF WORK:
Q2h 1\ 'I ,4oCD2d(n- Ohu-kki --S .
CONSTRUCTION INFORMATION:
Utilities: _Sewer Septic Sq. Ft. of First Floor:
Cost of Construction: $ 'I I.OL-Q. . Total Sq. Ft of Construction:
FLOODPLAIN DEVELOPMENT PERMIT for structures exempt from Building Code that are in the
floodplain:
Nonresidential Farm Building: Temp. Bldg./Shed used exclusively for construction :
Mobile/Modular for temp. construction office: Bldg. involved in distrib. of electricity:
Other: Flood Zone: BFE: Floodway? Y/N If Y,
No-Rise Certificate with_supportingdata attached? YIN. _.
All other applicable state and federal permits shall be obtained prior to commencement of
construction.
OWNER/LESSEE: CONTRACTOR:
1
N(\ l 2(-( f�c Ithfor 11 Name: fiYV)S,�I t . V__
Name N( �
Address: 1-4? ( }r)� LSS ( uii, 1)L. Company: -FlOrIrk- hLc't'f'CS�J 1 nn..
City: -p-5), ''\I� C� State:R. Address: .107 nn,,��(,,I,,���mrne rCe .
Zip Code:3 11 `�' Fax: City: \( (II) .(,t0A) State: Pi.
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Phone No. LQ 01-222 Ic2OZip Code: 329Leo Fax: L.Q7-31D 7 -1
E-Mail:fl() f(,l,(_.IV b 2 gi-,cuii 1 .ODYY) Phone No L r 2-' s [RC1- 22-00
Fill in fee simple Title Holder on next page ( if different E-Mail dal )P 1D.)A On-KM, 11(d krs 1 rl c .YI
from the Owner listed above) State or County License (lea./ DJ Szigs .
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
IIf value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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,
1 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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Signa re of Own �ssee Contractor LAas Agent for Owner ignature of Contractor/Licen older
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF ,t�,� COUNTY OF I�c o. n IR I( L(C) o 0 0 2
The forgoing instrument was acknowledged before me The for oing instru ent w,�aS�-acknowledge before -ems._ o-x t'
this_j day of �' OLY\ , 20 I Cf by this'2 day of NtA. I ,2011 by "a E E
O V V
r VT Cul l I�/L( —Theo ►.s L . fe Y z
Name of person making atement. Name of person making sta ment. '
-- "r.��:n-, .
Personally Known OR Produced Identification Personally Known OR Produced Identificat :i :::-/:,;-...-a.
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-
Type of Identification Type of Identification - '' ?:. '
Produce, P .:uced _ .
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/V r '.l U, _ �. _ 4.1412P2.11•••/ � ' 1[ 11a-'t'_
(Si- ure� of Not "• i L - .�•� �" ) (Signature of Notary Pu:ic-State of lorida )
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COMMISSION#GG267493
Commission No. ;,; s .1'ms:Nair 15'2022 Commission No. ti' ••;;v',;••.t• LEMIC:A'(SeaI?
ry�� s��� ,`. •
z, b-, Notary Public-State of Florida
Bonded Thru Aaron Notary ` _ • ` Commission a GG 103711
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGET.ATI( Dk�,- AzT � • ,t, ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 1/9/2019