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IAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (
Date: Permit Number: 1 vl Ky , OS5Y0
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:
Address: � f 5� o� &GO del
Property Tax ID #: c)4 _ �7 o) -
Site Plan Name:
Project Name: Z`��j l ( )J? L S
C9-" x ) / v
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping Shutters
_ Electric Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ `-�' Utilities: —Sewer —Septic
Lot No.
Block No.
rJ
Windows/Doors
Roof Pitch
Building Height:
OWN j SEE:
C««ONTRACTI±]R:
Name
Name:
I
Address: `� 4
/
4e/ C)
Company:
City: 1y21�_���
Zip Code ��11,,��Fax:
Phone No. 7�L- r' ??0
State: �
Address:
City:aTr �\�Qj\(�Q. State
Zip Code: Fax:
Phone No 0 --
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or Cou 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.
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�I
IEISIGNER/ENGINEER:
me:
Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
dress:
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 Countyy 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."
Signaturle of Owner/ Lessee/Contractor as Agent for Owner
Si ature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sic 4sz
COUNTY OFx
The for oing instrument was acknowledged before me
., �
The forgoing instrument was acknowledged before me
this day of 0 cam. 20A by
N*J, e—�nA 4x"-,
this IS day of (� p 20A_� by
1
Name of W2rson making statemen .
Name Aderson making sta ment.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Publi State of Flori )
(SignZiturb of Notary PubJi�
t . e of lori
, LASHAHNAINGRAM-RAHMING I
=?' °*_ W 6WISION11GG275060
Commission No. +
Commission 5i^AYPV9'. LASHAHNAINGRAMAWIPC—
:a¢EXPIRES: December20,202
";r-. 2
ii' ` = My COMMISSION # GG 275060
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Thru Notary PUbliC underr.
'tors
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
_MA" GROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/ 19