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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
.Date: Permit Number:
Building Permit Ap
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
PERMIT TYPE: rA -� 0-� W �
Address:
n MAY 6 2020
Permitting =nty,
went
` St -Lucie FL
Property Tax ID#: _ 6�iT 501— 10Mi— t)5D—Q Lot No.
Site Plan Name: Block No.
Project Name: C�L�✓�
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 Constructio : / c c/ Sq. Ft. of First Floor: _
U oG
Cost of Construction: $ Utilities: -Sewer _Septic
Windows/Doors
Y Roof Pitch
Building Height: 7J
OWIVER/LESSE -
C�ONTRACRGg,
Name
Name: .� .
Address: lzaelo
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City: Wq State:-
Zip Code: Fax:
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Address
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E-Mail: i% (J
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-M ail
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.
PL = E T L GONE t
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MORTGAGE COMPANY:
Name:
_ Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
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 Count yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 DIVAN ATTDR4iY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of 0 ner/ Lessee/ n actor as Agent for Owner
Signaturp of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The for Ding instrument was acknowledgoVefore me
The forgoing instrument was acknowledged before me
this day of 20:='V by
this day of 20_ by
) I tTi hck)
Name of person making statemen .
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identific,1 pp
Type of Identification
Produced '1� '...i/�
Produced
N�
(Signature of Nota I
(Signature of Notary Public- State of Florida)
•~;i;+•o"• AUDREY B. HUMPHR Y
•`-
"R
Commission No. MY CO $ ONRGG300817
�
Comm ission No. (Seal)
. ;•"Fail°'N• EXPIRES: 6,2023
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Bonded N Notary Undetwdtors
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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