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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9LI 9 1l 9 Permit Number: I "1oq C�
SF'P j1
Building Permit Applicatign '9
Planning and Development Services Ste CU"eDopa��e
Building and Code Regulation Division pf
n
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROMEMENT LOCATION:
Address: 70 SE ///OOtEO D2i i/,f i0p2i S%. u C 1 :7, FL 31V493 i
Property Tax I D#:9 4a 7- 7B l-0056 -000- 9 Lot No.
Site Plan Name: Block No. ,3
Project Name:
=AI11@1p1JE-8SR,1IP2T1lON OF WORK:
I�EPL/arCE14c4/T o7= Ex i .V6 WteyO0a✓$ 4 51-10i•v6 61/-/SS J70 OAS
WJ -r 0 VEE .TMPl+ C-T W, A,OOtUS � SL1yirt,6 61A.SS 000/'CS-
F•� 12 ' HO US4
CONSTR CTIONIfiI01' ION:
Additional work to be performed under this permit-check all that apply: /
_Mechanical _Gas Tank _Gas Piping _Shutters V Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: G Sq. Ft. of First Floor:
Cost of.Construction: $ / 3 S Utilities: —Sewer _Septic Building Height:
I WER/LE�S�RE CONTRACTOR:
Name /,/9111 6 I'll CNS L L tS r- 1 9- Name: M e,5 69 A/.S 7-a-a,C, 1 0 '
Address: 75-0 .SE H,, 00.e/Ll 21 vCC 01V UC Company:-AC�j�;UVn I D/LE . 12tc- kc/ >&t4R 0JU7'0
City:P02T S% Lv C i State: FL Address: 1-161 S w L4 /LQ , A VE
Zip Code:3 t/ 9 S 3 Fax: State:
IP-h6 rl'e"N'o: 77,E i 'Q7=30 g 8 Zip Code:3 y 9,5 Fax:
E-Mail: Phone No 7 7a : ('� 7- 30 Q 9
P P g ( CON$ 2u Ci/dN 77.2 (P6 GiM
Fill in fee sirh le Title Holder on next a e if different E-Mail/rlf�s,
from`ttie Owner listed above) State or County LicenseC G C IS-6(5-}o 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.
SUPP E ENT CONSTRt1CTI�N LI LAIN INEOR T U
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 AFFIDAVIT: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.
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of b7
r Lessee/Cohtractor as Agent for Owner Signature of nt ctor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF�Sr/,(//�,t.ti COUNTY OF GIJGt.�
The for ping instrume t wa acknowledged before me The for ping instrument w acknowledged before me
day of 20A by thi
this s day of S 20LT by
Name of person making statement. Name of person making statement.
Personally Known�_OR Produced Identification Personally Known OC OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-Ve of Florida) (Signature of Notary Public-Staq of Florida )
Commissionp 'ssion No. o7a�� 102- (Seal)
oa�Y°�e Notary Public State of lorida
My Commission GG 2 4292ov�'9s Notary ublic State of Florida
REVIEWS FRONT Z d E ffRWgG:2 PLA VEGETATION Sf. TYLetor 13 PWA10ROVE
COUNTER R REVIEW � NMyCo mis{yOV292
? b� "Expires 11/
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19
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