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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
II
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
PROP..OSED,IM'PROVEMENT, LOCATION:
RECEIVED
Building Permit Application SEP of 1019
permitting Department
;t. j_ucle County
Commercial Residential X
dd ress: I903 lJ k2 5 ,r wety , rmrl n y'ccQ F11 '-q 95 I
roperty Tax ID #: 13 D l - (9030 ! 12- 000 - 7 Lot No. 2e Zl
to Plan Name: Block No. 2—
roject Name: af-. CA I'
DET, ILED DESCRIPTION -OF -WORK:
�P �b inC!lT P �O �'!I IyIttcl
(i lil C) ✓i C o r r Ul] G L ,'nq C�d`� �U �� ' '7r�'"i I . ti' �` 7 S' V
'CONSTR�UCTIQNANFORMATION: .
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
f
_ Electric _ Plumbing _ Sprinklers _ Generator
I
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:I / �{ 2S0 °a Utilities: _ Sewer _ Septic
_ Windows/Doors
Roof �a Pitch
Building Height:
01NNER/LESSEE
.CONTRACTOR: {.
Namewi II (Am 6(AAVI)
Name: G tom/ ORIAt
!Address: 6 k.e5 t;zle- W cN
Company:#'% ha/44 goaF'l //? I '
City: State:
Zip Code:`!LjQ s 1 Fax:
Phone No. 7 jj_ No$•a5%9
Address: 3yj /$/A 41 St./
City: //t' State-B
Zip Code: 3291iZ Fax:
Phone No 772
E-Mail:0J' 0 ftivr' I.Cowi
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail � el �1a(VOMq: • 6wo
State or County license 0 ~i 9
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.
4
SIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zin:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
,OARMATION
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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.
I
he 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 COMM CEMENT MUST BE RECORDED AND
POSTED ON THEj6B SITE BEFORE THE FIRST INSPECTION. IF YOU 1 D TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR "F GQI"ENCEMENT:'
zo, " o-' 7 0 0 "0 i
Signature of Own essee/Contractor as Agent for Owner
Signature of Contr c or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA�,
COUNTY OF
COUNTY C
iThe for oing instrurgent was acknowledged before me
this day 20� by
The forgoing instrument was acknowledged before me
this T day of �3� 20—e by
of
i
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification+
Type of Identification
Type of Identification
Produced
Produced
C - '0_� DA 1,-Q
(Signature of Notary Public- State of Florida_)
(Signatureof N
: :,pY FG •• LAIWn G M-RAHMING
Commission No. ; �4• F -. l) 3# GG 275060
_'a,••' _ LASHAHNAINGRAM-RA ING
IS
Commission N m: :*; 'COMMISSION, 5060
L ;*; CQMMI
°a c`= EXPIRES: December _0, 2022
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a_
'F oP; EXPIRES:
pF 2022
Bonded Thru
•yOF F�„••'•11ondedinrumotatyrus
REVIEWS
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
IDATE
I RECEIVED
JDATE
COMPLETED
Rev. 217119