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INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Permit Number:
aecsveD
Building Permit Application AUG O
Planning and Development Services Pe SCtt` Cle C u tv nt
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: -� ! 0 , Z�?r.o%,�
Property Tax ID #: Wit • , n,5 -u?s'- tom- D((
Site Plan Name:
Project Name:
Lot No.
Block No.
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:
Cost of Construction: $ '600 d BO
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Building Height:
ODUNER/LESSEE b a
_ .
TRACTO kq
corn R
_
Namee C�S
Name:
Address: 4 I/�/✓�'G%D�% /�'l/�.
Company:
City: J564�6�6 �C_e_ Stater
Address:
City: State:
Zip Code: '; Y 9S Fax:
Phone No. �J�i�.^off
Zip Code,'Fax:' `
rrii�
E-Mail: 001
PhoreNoyL-;
Fill in in fee simple Title. Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License
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 Applica
Name:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Narne:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is her 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 vour Notice of Com-paencement.
Signature of Owner/ LesseefConitractror as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The f oing instr ent was acknowledge before me
this day of 20 by
The forgoing instrument was acknowledged before me
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati n
Produced iz � L4
Type of Identification
Produced
KA
( gn ture of Notary P lic- State of Florid
(Signature of Notary Public- State of Florida )'
Commission No. i�w, NAI 4MMING
Commission No. (Seal)
r. MY COMMISSIONS # GG 27WO
I•:;
:.
II 96
cem a
ryeib�'
0, 2022
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DATE
RECEIVED
DATE
COMPLETED
Rev. 9/26/18