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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED {} t
Date: Permit Number: � e
RECEWED
Building Permit Application FEe o oozo
Planning and Development Services Department
Building and Code Regulation Division c�ermi.Lucie C
St,Lucie County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PRO O- ED N"MaNE A.W.4 LOCATION:
Address: IU d�
Property Tax ID#:�ta )R (��=L3 (,!f Lot No.
Site Plan Name: Block No.
Project Name:
D TAILED DE�SCRlPiffins K1111MR1WIfilRK:
114
�� 31
CONSTRUCTIO`N INFORMATI•N:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/D ors
�
Electric _Plumbing _Sprinklers _Generator RoofPitch
Total Sq. Ft of Construction: � ,—� Sq. Ft. of First Floor:
'Cost of Constructiow,$; '���7� c� Utilities: _Sewer _Septic Building Height:
0W ER/LESS E: CONTRACTOR:
Name' Name-
Addre1s:::f,'' L Company:
City: State:_ Address:L S(1
Zip'Code: Fax: City:
Phone N Stat-.
�-L
Zip Code: � Fax:
E-Mail: Phone No l) ,3
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.
"' PLEME TAL CONSTRU ION LIEN LAW iNFa 0MAT-La
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 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 UST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TOGgTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF MMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signat C ctor/License Holder
STATE OF FLORIDA STATE OF FLORI
COUNTY OF COUNTYOF
The forgoing instrument was acknowledged before me The for ing instrument was acknowle of before me
this day of 20_ by this day of by.
Name of person making statement. Name o perso makin, g statgment.
Personally Known OR Produced Identification Personally Known \l//
Type of Identification Type of Identification 00 Notary public St�ofida
Produced Produced +P Trisha Neal H
mission GG 146949
OF Expires 10101/2021
(Signature of Notary Public-State of Florida) (Signature ary P I' o ,.!grjd ;Hutchinson
Atv: ::omm::•si;m,3G 146949
Commission No. (Seal) Commissio or., E\pi,es se�1 021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE-,'
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19