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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED mO
Date: _ Permit Number:
COUNTYRECEIVE
Building Permit Application
MAR 13 2020
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: VZ
P O INS 9 1 DI 1,MPROXIEMLNT LOCiATION:
Address: 19 0 '�> C. _5
Property Tax ID#: 3���• (.� I • ���' Lot No.
Site Plan Name: Block No.
Project Name:
DETA)l.ED DESCRIPTION OF WORK:
CONSTRUCTION INFORM T10N:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows!
/Doors ' '+
Electric _Plumbing _Sprinklers _Generator' - '110 of 7 /�i Pitch
Total Sq. Ft of Construction 0 Sq. Ft. of First Floor:
Cost of Construction: ,on Utilities: —Sewer —Septic Building Height:
OWN RJLfSSEE: CONTR CTOR:
Name n Q 0/V Name:
Address: . 1 r n Company:
City: r Aa'dr,.04- State• G Address:
Zip Code: Ci v Fax: City: State:
Phone No.e p? 62,95-0 Zip Code: Fax:
E-Mail: 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.
,UPPL BO01CONS TRUCTIC>N Li N W I! T t7N:
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 wo'rk'an_d ihstaIlation 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,'tihat 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 YOUJZ LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Ov/ne /Lesspe/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � �. )(��Q COUNTY OF
The f ling instrument w s acknowledged before me The forgoing instrument was acknowledged before me
thisj�day of 202ay 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 Identific'��j°� Type of Identification
Produced A% L Produced
(Signature of Notary - (Signature of Notary Public-State of Florida)
"vv,,, KAREN'S. NIELSEN
♦SDR Uq//
Commission No. '2° `�-State of� lo�ri�la Notary Public Commission No. Seal
Comm , i # GG 207484
9rEOi °`�� My Commission Expires
"` June 1 9- 9n99
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19