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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:UR
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a Building Permit Applicati ,, 49
Planning and Development Services �r 4 '?P°ep1)rt
Building and Code Regulation Division COGnt�eot
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential J�
PERMITTYPE:
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Address: s614Z, t}Ve-
Property Tax ID#: 3' 19. 15'y0 `09105'- 0000 Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed. under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shulers _Windows/Doors
Electric _Plumbing _Sprinklers _Generator JZ'Roof Pitch
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Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction:$ Utilities: _Sewer _Septic Building Height: � I
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Name UeS� LVIs kvvz- 04"0 Name: `1ZOyef7, rt,-ILie Z
Address: 10Gl 5;6 •S0(Q2- -t_/�P_ Company: 2-6 e'eo!5yLYy 'y 57�eWic'--,
City: `0(+ 5- I,P State:- Address: Kjr
Zip Code: 3 4 193 Fax: City:_A41.AW11 State:
Phone No. Zip Code:--331 to �9- Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail e0'►s4 &t;,o✓!S - cfMira IT lOrk�
from the Owner listed above) S� tate 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.
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S,UPALEMEN 'AL CONSTRUCTION LIEN LAW iNFORMATiOCf :£, 3
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: to
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 MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR ANA N Y BE RE RECORDING YOU NO ICE OF COMMENCEMENT:'
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Signature of Owner/Lessee/Contr ctor Agent for Owner Sign re of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF �lA�'1-Q COUNTY OF Mckmi—DA&
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of R6 20'20 by this 13 day of T,el®ruAff 20'20 by
'►-0,W01 On.—e- -
Name of person making statement. Name of person makingstatement.
Personally Known OR Produced Identification Personally Known ✓/ OR Produced Identification
Type of Iden ification _ Type of Identification
Produced Iden
Dive_p LLCe� Produced
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aYP� KAREN CHAVEZ
z ommiss 6#GG 155059
(Signatur of Notary Public-S t� f I idBlikabeth Roberts ( nat re of Notary Pu 9 on xpires 10-26-2021
Through•Cynanotary
y. My Commission GG 937056 ��E� Florida-Nota
xpues 12/04/2023 �/� Notary PubIIC
Commission 1\14Aa 7 0F� SFeal) C mission N0474 Is
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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