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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Num
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C� afra l � i1la r 4�{�
� APR 21 2020
Building Permit Appl cptioq
ermlLting
Planning and Development Services Department
Building and Code Regulation Division St. Lucie Caun �, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: /Y I ,le f-/L - e. 172
L•/ /y�
Property Tax ID #: 3Y0 — G a 2, — O D 6 — o 0 o S (36 Sal Lot No.
Site Plan Name: i2Od2 Block No.
Project Name:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 52�z 0 Sq. Ft. of First Floor:
Cost of Construction: $JIRC9 d B a Utilities: _ Sewer _ Septic Building Height:
Name /Je /` e— s Kr//S Name:
Address: Z-/ �`7LXe e ,02 Company:
City: D. G 2 c e State: e& Address:
Zip Code: 3N992 Fax: City: State:_
Phone No. 7 7 2 ' .Z / 6' h S/G 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.
Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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."
S Lure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA �1�
STATE OF FLORIDA
COUNTY OF eJ /
COUNTY OF
The forgoing instrum t was acknowledged before me
The forgoing instrument was acknowledged before me
this�day of�20�pby
this_dayof 20_ by
-7r-1-t 2 SyAa /J.
Name of person making statement.
Name of person making state/Proced
Personally Known OR Produced Identification
Personally Known Oentification
Type of Identification )
Type of Identification
Produced / / rC.
Produced
(Signature o
(Signature of Not Public -State of Florida )
;Rti'°4Bti,; AUDREYB.HUMPHREY 1-
Commission No.
COMMISftNPGG!%' �'
Commission N (Seal)
EXPIRES: March 6...
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SUPERVISOR
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DATE
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COMPLETED
Hev. 2/ // 19
-I AUDREY B. HUMPKEY
MY COMMISSION 0 GG 300817