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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y� ! /'1
Date: 7 /66 // 9 Permit Number: ' lJ 'u q!
Li iia-Y T RECEIVED
F L O R 0 Di Pi. --:
Building Permit Application APR 16 2019
Planning and Development Services
County,Building and Code Regulation Division ST. Lucie Cy! Perrnittin
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential V
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PERMIT APPLICATION FOR:
PR@ D @SED ON PROVEM ENT,LOCATIONS o^. .
Address: 93 D l�-y3 C.d4cLe_ gS't 3 alS2-
Legal Description:
Property Tax ID#: 2` I . Vii ' 3 j', ; a ' o • aLot No.
Site Plan Name: Block No.
Project Name:.
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Setbacks Front Back: Right Side: Left Side:
E l AILBD DESS+IRIPTION ,C WORK: a _ . ��. '. v
0V OCC /yc ...54(57.7744._27.7.5.7---Aa., IK iMJ..LY / r.J,rr-//:94u>A.9i !1._)
1_(2977/4 'o Ac/.5 .v , 44.)z)�,JsE2 c,00/1 ,',E,.4//_,',__
Ja ---- 1, 0 L /5---5
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CONSTRUCTION NAP 0 RMATION, . . .
Additional work to be pertormed under this permit-check all that apply: I
/Mechanical '_Gas Tank _Gas Piping _Shutters ` —Windows/Doors
Electric _Plumbing _Sprinklers' _Generator _Roof Pitch
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Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 5777-640f-14-2- Utilities: _Sewer _Septic Building Height:
CA1,IlN@ /LE=SSEE CONTRACTOR?'fi
Name .p4- NAV6/1---- /n/0N Cif- ,.5-4-66///2 Name:,60,0414-D Op-6:z.Gi5 -,7- -
Address:
Address: 75 5- , yS c cII (.e._ Company: ii!-e,./0" A ,cry Tio,J .�:c)G
City: ,! ' 5!/f iE, I State: Address: goF6,e,4 S /ly
Zip Code: 31(9S' . I Fax: —/ City: STj4c/g State: 1,...
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Phone No. 7'7 ?i o8 9t//' �{v Zip Code: ,N-9-5-2.- Fax: ----
E-Mail: -- Phone No 772 --a/3 s'.'9
Fill in fee simple Title Holder on next page( if different E-Mail �'LG ,s /2 I3 c.€77/,CC 5oi�{e i 1
from the Owner listed above)vState or County License -_ 7/3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
0 o A Cl0NSlikt) IONa LAMP'P®RMAT 0 1 q�.# , K
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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
commencing work or recording your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ' -c, V i jeM COUNTY OF / • L_Cie/1(-_,
The fo going instr me nt was acknowledged before me The forgoing instr ent was acknowledge before me
this l day of r; ,2019 by this (p day of 20 f� by
.>01WLI S ' cliiQnt. co Gs s L)r
flame of person making statemenName ofperson making statement. Name
statement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification ✓
Type of Identification Type of Identific n
Produced (� Produced cI lJ D�
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(Signature of Nota -- F ._, - •, .w..�
KAREN S. NIELSEN (Signature of Notary P
=o`�YPUa��;state of FI id Notary Public ,"T" KAREN S. NIELSEN
Commission No. ,, ejiiLe��s
e Ja�'= Commis. GG 207484 - Commission No. �' /:� State of F(SQ,:::)Notary Public
; 1 rioa My Commission Expires • Fz*/"'\•_ Commission # GG 207484
June 12, 2022 �'9IAJo My Commission Expires
r,
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
rev. 8/2/17