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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f Permit Number: ` —054
- — — - _— Building Permit Application RECEII/ED
Planning and Development Services DEC 2 7 2919
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting Department
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentiaf Le Count,
PERMIT TYPE;
Address:
Property Tax ID #:
Site Plan Name:
Project Name: _
5
Lot No.
Block No.
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: 3 W
c-Qstrof eonstryction•.: 006
Generator r - Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
N&e AUK lbres
Name.
Address: lei CA of
Company:
City: 0 l
Zip Code: Jr Fax:
No. 0
State:
!I
Y b ' ✓ b
Address:
City: State:_
Zip Code: -- Fax:
Phone No
(Phone
E-Mail
XJ0LjF10 0 NG111 6041
Fill in fee simple Title Holder on n xt page ( if different
fom 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 CONSTRUCTIO LIE- LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: ', _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 OwnersAAssociation 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
URNET 6EFURE RECURRING TOUR NOTICE OF COMMENCE
as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 5`— Ul,- f '—
The forgoing instrument was acknowledged before me
this -?-7 day of {art Q 20IQ by
D too ICIOrY S
Name of person making statement.
Personally Known OR Produced Identification
Type of Identificat�_L'b
Produced
State
Commission No. H°'?rlll!Wk, �ommisFS�Aly GG
REVIEWS I FRONT ONING
COUNTER I REVI W S REVIEWOR
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW