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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '\�
Date: L I—�S i�b Permit Number: o D CH— 0 3 03
Building Permit App
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1579 Commercial
PERMIT TYPE: J�� W L'-
Address:
N-
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Property Tax ID#: 340a-boS'oo('I�-0o0(a Lot No. J
Site Plan Name: Block No. 33
Project Name:
- a-K Ska&ej SiavteyertCef h �) e r ems) �I e ri r P
Additional work to be performed under this permit — check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: _ _ Sq. Ft. of First Floor:_
i .
Cost of Construction: $ Z'S ID D • () O Utilities: _Sewer _Septic
-Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRA TOR:
Name TaMLS. 1—m�
Name:
Address: C4}7'n(-, KA&JJvlD lk ti(,
Company:, ---
City: (06'f e Stater
ZipCode:: 4q$i- Fax:
Phone No. 9-61-314 -b34s-
Address;
i6
City-'!!
Zip Cone `_ __ - " ^ " fax:...
Phone No
:.IiState:_
E-Mail: t—�'(` SILO+, doovl
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
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.
L%UEMS A CO 5TR
DESIGNER/ENGINEER:
Name:
10 LAW
_ Not Applicable
N:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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 AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
1-107- 4AI-7 1
Sign re f Owner/ Lessee/Contractor as gent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Qi
COUNTY OF
The forgoing instru eept wpssaacknoowwledged before me
The forgoing instrument was acknowledged before me
thisLqq day of /_��^� 2t by
this _day of 20_ by
�i6LlL�2�S 4fR— <'!Cz
Name of person making statement. /
Name of person making statement.
Personally Known OR Produced Identification ✓/
Personally Known OR Produced Identification
Type of Identification
Produced_k J� C.
Type of Identification
Produced
(Signature of N P b I-
(Signature of Notary Public- State of Florida )
•,;sro." AUDREYB.HUMPH R
••
Commission No. .� OMMISIM" G300817
Commission No. (Seal)
c EXPIRES: March 8, 2023
nUnder*11IM
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/1.9