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ALL APPLICABLE INFO MUST BE COMPLETED FOR'APPLICATION TO BE ACCEPTED
Date: Permit Numb r•
KCLot:JLV E. [)
051
-
- . JUL 2\3 2019
Building Permit Application
'Planning and Development Services Permitting Department
partment
Building and Code Regulation Division t. Lucie Co u n t
123W Virginia A �,venue,Fort Pierce FL 34982 yi 1'L
(Phone:(772)462-1553 Fax:(772)462-2578 Commercial Residential
HERMIT APPUCATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT lOCATIN
Address: OS
LI gal Description: ( e
�-3 s 0 � Z3
Property x ID# 13 O ��G"O l TF -GQU —3 Lot No.
Site Plan Name: F Block No.
Project Name:
Setbacks. Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
�w6 shy &k7 CA_f,
CONSTRUCTION INFORMATION
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Additional work to be nerformed un er this permit—check a app i
I aHVAC []Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing 13Sprinklers R Generator O Roof
otal Sq.Ft of Construction: c� Ft.of First Floor:
Cost of Construction:$ IF Utilities: Sewer E]Septic Building Height:
(OWNER/LESSEE CONTRACTOR
Name E '/'lc Name: 91C. . . �.
Address: apr��
Company: Ic
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City: ( S e•` Address: L 3
Zip Code:3, Fax- City: Pf 1 State•
Phone No._ '-'&3 1�- S Zip code:�3 c frl��" Fax: 7 7 a?-"7ji 6o T
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the owner listed above) State or Coun -tense:
N value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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1
DESIGN ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
C* State: Ctty: State:
tip: Phone: �— Zip: Phone:
FEE SIMPLE TITLE HOLDER:• ' , Not Applicable BONDING COMPANY: Not Applicable
Naive: Name:
Address: -
Address
CIW.f Phone: Zip- Phone.,
1 txrtify that no work or installation has commenced prior to the Issuance of a permR.
St lade Coo makes no cep on that is granting a it 1 a atrize they holder t4 build the subject structure
whkh is Cn oonflid with aw appG a Home Owners A�rules,b�axis or and cwimnts that may r�estrlct or pnghibit such
structure.Pltease eoruatit wWLYour Home Owners Assodation and renew your deed for any�trl�ons which may apply.
In co axon of the granting of this requested permit,I do hereby.agree that I will,in all respects,perform the work
in a000rdance with the approved plam the Florida Bulks ft Codes and St Lucie County Amendments.
The ltdlowirig'brindfig permit applications are exempt from undergobig a full concurrency review:room additions,
accessory structures,swimming pools;fend,walls,signs,sawnroomspand accessory uses to another non-reddential use
WAI RNIMG TO OWNER:You failure ta R�ord a No�tioe of CommenomrreM may resuk in yotir o Ong Udw for
imp'rovements.to your property.A Notice of Commencement must be recorded and{posted on the jobsite
before the first inspection.If you intend to obtain finan�dng,consult with lender or an attorney before
ism cin work or reoordin our N of Comtnencer>ite
ft*ture of Owner/Agent/Lessee Signature of Hol er.
STATE OF FWRID - STATE OF FLORID
COUNTYOF COUNTYCIF
fbefts adarowledged 7tie m was admowledged beforeme
tfiis ,day of ZO thk of .20�,¢by • .
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(Name of person ) (Ififneofposdaadahowlet")
(Sishatum of Notlo
PuJ byeof Florida ls>Bnaprre of Ttotary staToe of Florida)
Personally Known / OR Produced tderaification Personally Known OR Produced klevitification
Type of Identification Produced Type of identification Producer
Conuniss on No. Commission "�P' •. D EY S.HUM 1)
--*VDREY B. REY
i° ,; MY COMMISSION#GG 300817 -
,: MY COMMISSION#GG 30084Z ,,;
.cam :�• o. EXPIRES:March 6.2023
Bonded ThN Notary Public nderwriters FOF F;�•' Bonded Thru Notary Public Underwriter;s
•POPE`;.°•`` U ;,.
P. O1
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REVIEW FRONT ZONING SUPERVISOR PLANS VEGETATION sEATURTLE MANGROVE
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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COMPLETE
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