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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,r
Date: Permit Number:426o UqO ti)
i
RECEIVED
R.R.IS 2020
BuildingPermit
A Application
} pp onPermitting hLapartment
Planning and Development Services St.Lucie County
Building and Code.Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 7�
PERMIT TYPE:
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Address: LD( I 'P n.e+ -C-e
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Property Tax ID#: �T 0 l 3' a� o� Lot No.
Site Plan Name: Block No.
Project Name:
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D TA L D DE�SC■ 1 TON OF WQR
4onV up WA6._
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SONS �UCTIO' INFOR ATIO
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
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_Electric _(Plumbing _Sprinklers _Generator _Roof . Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
-Cost of Construction:$ Utilities: _Sewer )t Septic Building Height:
OWN�� /LESSEE: �N RACTO
NameName:
Address: LA 641 P!n&_-Vc�C ]b('+ Company:
City: PAn _Pi 4t c,t State: r-L Address:
Zip Code: '54Ok a. i Fax: City: -State: {k
Phone No. "1"12L• c10L r-.gL0( Zip Code: Fax:
E-Mail:Jk5Q.k1 @ GMAIL.CoAl 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.
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S 'P ' LEMENTAL�Of�STR�1 O � I �* ATION.
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*prohibit such
structure. Please consult with your Home Owners Association and review your.deed for ariy restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby-agree that I will;in all respects, pe�iorm 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 YQUR.LIIENDER O N ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." .
Sign atuurr'd war/Lessee Contractor as Agent for Owner Signature of Contractor/License Holder
STAT//E/OF FLORIDA STATE OF FLORIDA
COUWY OF COUNTY OF
The for ging instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 200-0by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known` OR-Producedldentific`ation - - —
Type.of Identification Type of Identification
Produced �( _ T)L J Produced
(Signature of N tary lic-State of Florida) (Signature of Notary Public-State of Florida)
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Commission N ;`��"`P�a;. ELLEN V,990t�HN Commission No. (Seal)
Sidi t Florida-Notary Public
-' *c Commission # GG 27007
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