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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C7
Date r " 1 1 Permit Number: �;1� - O
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_ Building Permit ApplicationJUN 2,, z019
Planning and Development Services pertnittin
Building and Code Regulation Division St.Lt. eparme
2300 Virginia Avenue,Fort Pierce FL 34982 cr` aunty nt
'Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
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Address: d Ov kq
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Property Tax ID#: 39�^ uoq— �y�11'� I'� Oo Lot No.
Site Plan Name: Block No.Sii�—
Project Name:
Go /
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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:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
M.
Name .a Name:_-a/id 4 g�g
Address: . 66 uric 0U Company:
City: ' �r�L,�= State:_ Address: c5f.5 cTG1
7� cr7- 11 C.
Zip Code: !3 Fax: City: ��� State:
Phone No. "L`2i , 9 7 G -.2.5" 7 Zip Code:. Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License_ S"i
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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: T
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 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."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA . STATE OF FLORIDA,--% �
COUNTY OF � "l COUNTY OF l
The for
in instrument was acknowledge efore me The forgoing instrument was acknowledged_b fore me
this day of ,; 20 by this !�qay of \&SC 20�
. V)kN\,Wp AV y?,0d O 0 11-1,- �A JJ"
Name of person making statement. Name of person making stateme t.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced Produced -F—"-
(Signature of Notary Pu lic-State o Florida) (Signature of Notary Public-qStfof7FI'=or-id.a))
Commission Np,�.. ��y w Commission N itu„r„
ELLEN VAl1GM a —GLEN VAS N
• _,. �`.'-,..,.a,c of Florida-Notlry =}° r State at Plarftla;Nataty.Public
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REVIEWS �•:.FidJT ,r ion E pires o,;nr��, Y Comr» in2d Aires
t�DV '2,2 2.iUPERi'ISOR PLANS V OVE
_ REVIEW REVIEWREVIEW W
DATE
RECEIVED
DATE
COMPLETED
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