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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z f C� Permit Number: OA
m
RECEIVED
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Building Permit Application AUG 2 7 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential )(
PERMIT TYPE: "OK�
F?ROPOSED IIUIPR(3�JEMENT'LOCATION
Address: f<j O O �J A I A
Property Tax ID#: t L���^ �d b r - Q�j 6 /7 Lot No.�_
Site Plan Name: Block No.
Project Name: ASILC �St C.rVCf=
DILED DESCRIPI`ION&OF;WORK
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C0NSTRUCTI( 11C INORMATtON `
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: $ vrd�� Utilities: —Sewer —Septic Building Height:
;,CONTRALTO
_
Name - 're iiNv l-LSA DA s,L-t_ Name: U XU El.cc tj c- Ea tir c.
Address: 3-702 AJ 81A -FP-309 Company:
City: �P-J . NXoZ7 State: (=L Address: 22,� V12-"V_1 4 -7
Zip Code: 3`J!J Fax: City: (n State:
Phone No. Zip Code: Fax: �S6(-7�IY-�tZ60
E-Mail: Phone No --2 '77-6Z
Fill in fee simple Title Holder on next page(if different E-Mail rise e c, r,` G
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.
SIJPRLEMENTAL C NSTft PIQWL" LAIN IPF
NFORMATION
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 thepermit 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 J SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDfWOAN ATTORNEY BEFORE RECORDING YOUR NOTICE CO ENCEMENT."
C'1_4�7
Signature of Owner/Less ee/C ntractor as Agent for Owner Signature of Contra ctor/Lice n s Holder
STATE OF FLORIPft STATE OF FLORID
COUNTY OF_ M, f t,-E- COUNTY OF
Oa
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 17! ay of (�x h6yt,5`r— ,20-0_ by this al- -day of &,AS= 20-a by
Name of person making statement. Name of person making statement.
Personally Known �OR Produced Identification Personally Known V/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
64 A ",4 1
(S gn ure of tart'Public-St .a. ri L#GG 134629 (Signa re of ry Public-State of F BNL
October 29.2021 # . C�omwhsion#GG
Commission No. -d r `y' Y (MM2 Commission No ' �vFtti� )
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19