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LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
0-16 `% Permit Number:
Building Permit Application
ing and Development Services
ng and Code Regulation Division
Virginia Avenue, Fort Pierce FL 34982
e: (772) 462-1553 Fax: (772) 462-1578 Commercial
Residential
PERMIT TYPE:/fIG . 1V4'I"^6,,%—
PROPOSED IMPROVEMENT LOCATION:
l� Address: �l �� D ��C'J�SP.t/l .
Property Tax ID ;
Site Plan Name:
Project Name: _
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
A, \AAM r
I CONSTRUCTION INFORMATION: I
AI ditio work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
j _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
C I ost of Construction: $ -1 s- Utilities: —Sewer _Septic Building Height:
Pitch
-OWNER/LESSEE:
CONTRACTOR:
,Name io
Name:
Company:
Address: �J �1
' Q,S
'City: @1S\S�JY` State:
Zip Code: Fax:
Phone No.
Address,S�✓ r
City: �►��— Stater
Zip Codex3\RFax:
Phone No`nz
E-Mail G��CQ C' �CSZSe
E-Mail:w1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
I
WNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
:ertify that no work or installation has commenced prior to the issuance of a permit.
Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
rich is in conflict with any applicable Home Owners Association rules, bylaws or and covenants.that may restrict or prohibit such
•ucture. Please consult with your Home Owners Association and review -your deed for any restrictions which may apply.
consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
e following building permit applications are exempt from undergoing a full concurrency review: room additions,
cessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
EARNING 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 Owner/ Lessee/Contractor as Agenffor Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
�&A
;COUNTY OF 41P tip,
COUNTY OF LC k_o ,
!The forgoing,,instr ent was acknowled ed before me
this � day 20by
The forgoing instru ent was acknowledged before me
of
this] day of 20�G by
Name of person maki g statement.
Name of erson making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signa ure o otary Public- S e of Florida)
(Signature of Notary u u a
�'•
Commission No.
= = NAHNA IN
?A: iWC G '�IiMIfNG
ommission No. :; IMGG2750o0
..........
Nr
. '�+ .,. IASHAHNAINGRAWI-RAHMING
•°p °"•`'• BMded 0.2022
REVIEWS.
FRONT
'?,
EXP
F �Bf&7ft
December 20, 2022
PMV�1
PLANS
-VEGETATION
SEA TURTLE
MANGROVE
COUNT
EVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19