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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
COUP
F l n
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578
Permit Number:
Building Permit Application
PERMIT TYPE: V, I C--1"—F
PROPOSED IMPROVEMENT LOCATION_
Commercial Residential X
Address: -7,-; l-Ia
-
Property Tax ID #: J2✓ �� (1 f Oti�iS --00 `� Lot No.
Block No.
Site Plan Name:
Project Name
DETAILED DESCRIPTION OF WORK:
0
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank — Gas Piping _ Shutters
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $��
Sprinklers ^ Generator
Sq. Ft. of First Floor:
f— ''NO A f— —
— WihdRs/Doors
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
Name
Address:
City: �a_(4- S 1_Vcj�— State:i
Zip Code: Fax:
Phone No. 7-7
E-Mail: ()01111y.c�d�A1
Fill in fee simple`Yitle Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: JAMES E REYNOLDS
Company: CORAD INC
A,4,4rp«. 2771 VISTA PKWY STE F11
City: WEST PALM BEACH State: FL
Zip Code: 33411 Fax: 561-771-0049
Dhnna Nn 561-771-0047
F-Mail REBECCA@PERMITGROUPFL.COM
State or County License CGC 054348
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: — Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone:_
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
tate:
Not Applicable
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."
v
Signa ure of Ow er/ Lessee/Contractor as Agent for Owner Signatu of Contractor/License Hold
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY OF PALM BEACH
The forgoing instrumt was acknowledged before me
this 1 day of _ aIIiIf'_>. 20 �-O by
JAMES E REYNOLDS
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced t— ~ NaafiPubkstate ofFlorida
•"-__R8b0= E Stephens
Cornmituon 958848
�q V F.E xpirsa 02/ t 8/202424
I
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
I�ev��
The forgoing instrumf nt was acknowledged before me
this day of Ic ^J`— 20"'� by
JAMES E REYNOLDS
Name of person making statement. /
Personally Known ____
OR Produced Identification
Type of (dent ication
Produced L
_ -.- Mary Public Scats of Plw4a
Rebecca E Stephens
My Comrrussion GG 958648
M Expires 02/1St2024
(Signature of NotaryT_ublic-State ofTlorida )
Commission No. (Seal)
S REVIEWIS OR REVIEW
I VEGETATION PLANS EVI WI S REVIEW LE I MANGROVE