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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: E(P&1,lLf6imber.
NO MAY 21 2020 - -�
ST. Lucie County, Permitting
Buildin PPii�ion 10
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
PERMIT TYPE: Cqf Dr-f-
Address:-: D? Lx- (e
Property Tax ID #: 1 1'I 3, — T) O I (� �� lal Lot No.
Site Plan Name: Block No.
Project Name:
3
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: I'�i►1 7C 91l X 391 Sq. Ft. of First Floor:
Cost of Construction: $ onn Utilities: -Sewer _Septic Building Height:
Name V c'e\f4 . ix-;:�Kk-
Address:: tt40�( Company:
City: tip State: 0L• Address:
Zip Code: LO�'-i(-f Fax: Ci State:_
Phone No. l- H b ar 04 8 a'as63 Zip Code- Fax:
E-Mailc 60 M\� o It% �� 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 $7,500 or more, a RECORDED Notice of Commencement is required.
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MORTGAGE • Applicable
Name,
DESIGNER/ENGINEER: • Applicable
Name:
i••
Address:
City: State:
Zip: Phone
City:
zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING / Not • • • '
Name:—
••
Address:
City:
city:
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I"certify that no work.or'installation has commenced priorto the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with,your Home'Owners Association and review your deed for any restrictions which may apply..
In consideration of the granting of this requested permit, I do hereby agree that I Will, in all respects, perform the work
In accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. '
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO.OWNER: Your failure to Record a Notice of Commencement may result in. paying twice for
improvement.s,to your property. A -Notice of Commencement must be recorded inthe public records of St:,
Lucie County and posted on the jobsite before the first inspection. -If you intend to obtain financing, consult
..Ak 1e.,,4e. .., �. pf*nrnpv hufnrc rnmmpnrinn wnrlc nr rprnrdinB vnur Notice of Commencement.
i
Signature of Owner/ L s e
ntractor as, ent for Owner
Signature of Contractor/License Holder
�3�y^$'l�'�y-
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STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 6 �r_ Lo c f—
COUNTY OF '
Sworn to (or affirmed) and subscribed
before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or
_Online Notarization
_Physical Presence or. online, Notarization
this 'IN day of `rNo;�A.
a 20�by
this _ day of 20_ by
y¢r\¢d,-n VN��,
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced `
(Signature of Notary Public
- EIWNAMARIE GNENS--
• ignature of Notary Public- State of Florida j
Commission No. �*��'
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REVIEWS FRONT
ZONING SUPERVISOR
PLANS VEGETATION ' SEATURTLE MANGROVE
COUNTER
REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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