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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: q -ZI- Z620 Permit Number: �� 10385
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: 3 NE 17
I PROPOSED IMPROVEMENT LOCATION:
Address:-2 7A 9 T UV I IV & R1 r 4:; f el-ce , F-L 3 yQB I
Property Tax ID #: 3 4 0 3 --50 2 —0126 —00 0 6 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION • •'
"-WNSTRUCTION e' •
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank tGas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ q C) 0 0o9� Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i 1
ame:
Address: 2-7A5 'J)P ✓hJ2 k-8
Company:
City: fir r P i 2enA State: rC-
Zip Code: 3 49 A I Fax:
Phone No. 77-Z.- '419!- 463 6 /7 72,-3 3z- 11949
Address:
City: State: —
Zip Code: Fax:
Phone No
E-Mail:4;Pt10Jlvar`b QM.XLA -rA-in
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:.
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
-� Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conWict 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."
.tLt go V'JA�J'�—�
nature of net/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF LORIDA
STATE OF FLORIDA
COUNTY OF Js� LU GI,P
COUNTY OF
The forggoing instrument was acknowledged before me
sr
The forgoing instrument was acknowledged before me
this day of [_'q✓ 20rby
this _day of 20_by
6qrz9 Au S s-C�-
Name o�king statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced jA� ��.
w
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. ,
ELLEN VAUG
ion No. (Seal)
N
Mon
4P oc State of Florida -Nola
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REVIEW
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DATE
RECEIVED
DATE
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