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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
.Date: Permit Number:
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Building Permit Application JUN 2 6 1019
Planning and Development Services permitting p,Fartmenp
Building and Code Regulation Division St' L`1C1e Coenty
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Y _ Residential
PERMIT TYPE: -
PROPOSED IMPROVEMENT LOCATION
Address: »
f �? 9
Property Tax ID M 19 2 z__ //3- Otxi/_ ®a4- � .� 0%//3X000/ C7J0 �v Lot No.
Site Plan Name: Block No.
Project Name: zz a
1DETAtLED,DESCRIPTION.OF WORK
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Ca:N5TRUCTIC?N INFORMATION
Additional work to be performed under this permit–check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
X Electric i Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 62,Q?A duties: —Sewer —Septic Building Height:
OWNER/LESSEE. s: CONTRACTOR
NameA Name /Zt
Address: n/ Company: d?`�
City: State:� Address:�43 td. /0»3'
Zip Code: Fax: City: leJlev Stater
Phone No. Zip Cade: Fax: q4t r
E-Mail: Phone No YG/- 21077
Fill in fee simple Title Holder on next page(if different
from the Owner listed above) State or County License EC/3 00-.58-59
s�. 7
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.
SJPPlEMENfl A!CC�NSTtUCTION LIEN LAWINORMATIQN r € t �
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DESIGNER/ENGINEER:
Not Applicable MORTGAGE —,,X 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.
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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 JO,XL,SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEND OR),AN ATTORNEY BEFORE RECORDING YOUR NOTICE OFC M CEMENT."
Sig a re of Owner/ ssee/Contractor as Agent for Owner Signa re of Contractor/L' ense ffolder
STATE OF FLORIDA �Jr C��hFLORIDA�
COUNTY OFCOUNTY OF ,_ �`
The forgaing instrurrlent w acknowledged before me The forgoing instrument was acknowledgWby efore me
this_2rday of iU 20� by this�Y"""day of ('aiye' 20
Name of person making statement. Name of person making statement.
Personally Known v OR Produced Identification Personally Knowny OR Produced Identification
Type of Identification Type of Identification
Produced Produced
&a4t-ot 04Le
(Signature of Notary Public-State of�Flopr�ii a� (Signature of Notar Public&WRf�ida)
Commission No. NOTA
� x'TE 00 BLICORICommission N �T ��I)
.5CMComm*FFB27M Comm#FF027M
Expires 11/13/2019 res 1111132012
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 211119
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