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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE.ACCEPTED
Date: ` _ Permit Number: .L. �I
RECEIVED___
Building Permit Application JAN 0 9 2019
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: �0 O'r
Address: F0 G X m o I�IA rix
Property Tax ID#: 0 (e)n �0 Lot No.
Site Plan Name: Block No.
Project Name:
i3A >� AIRW ce;674�-
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:$ L 75, Cid Utilities: _Sewer _Septic Building Height:
Name LbA oA4 J> ,L�-! �''�r/✓�7 �� Name:
Address:S'�� 0��,�1/L/� A41� Company:= -- �..
City: 587T F/sZIe Jr, State: �Z— Address:
Zip Code: ,S /`J S7 Fax: City: - T State:
Phone No. 772- 5-79 Fr< <" Zip Code:j .Fax:
hJ67 Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
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. .
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY B ORE_RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Own r/Lessee/Contract o t-for Owner Signature of Contractor/License Holder
-STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF b COUNTY OF
The f going instrufnent was acknowledged efore me The forgoing instrument was acknowledged before me
this day of 20�y this day of 20_ by
Name of person making statement-/ Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identif tion Type of Identification
Produced L Produced
(Signature of Nota (Signature of Notary Public-State of Florida)
i ;YP;a, KAREN S. NIELSEN
PA
Commission No. State of Fl�rA Notar Public Commission No. (Seal)
-
commis GG 207484
;rtoF`oP� My Commission Expires
june 12 2n,)9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
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