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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
F
Building Permit Application
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 X
PERMIT TYPE: SOLAR -Photovoltaic
PROPOSED IMPROVEMENT LOCATION:-' .
Address: 4JUU Avenue U Fort Pierce, FL 34947
PropertyTax ID #: 2406-113-0003-000-0 Lot No.
Site Plan Name: Block No.
Project Name: Beatrice Burns permit
,DETAILED DESCRIPTION OF WORK
roof
CONSTRUCTION INFORMATION ,_ , ;;:
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: _
Cost of Construction: $ 28500
Sq. Ft. of First Floor:_
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name_
Name:
:tr
Address_4200 Ayer+ue, Q
Company:F1DriAa
Parr ManaQernenl-
City: Sri- ?N"C-,e- State:'F
Zip Code:'2,I,4q(tl Fax:
PhoneNo. 112- 2-61-
Address:_ t331 GCgeh F0r0CJ' C+. a 3
City: UJ�nt-er Caat-de-t-,
Zip Code: ;41 19-1
Phone No 401-554-
State: Fi-
Fax:
204-1
E-Mail: gero-- h\1fKS Gr,- !2 MO�cn
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
E-Mail )enr o, Co
rn so lrna . c o r-,-s
State or County License
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IT vdme or consrrucnon is pzbuu 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.
SUPPLEMENTALCONSTRUCTIONIIEN'LAWIINFORMATION.'
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
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 County 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 andSt. Lucie County Amendments.
The following building permit applications are exemptfrom 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.''
Signature of Owner/'L ee _ ontractor.as Agent for Owner
Signature of Contractor/ ' ns older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF n ro..
COUNTY OF Y_)'
The forgoing instrument Was acknowledged before me
- The forgoing instrument was acknowledged before me
this 24_ day of MT 202a by
this day of M G-20_U by
Name of person making statement.
Name of person making statement.
Personally Known OR Prod Identificat'
Personally Known OR. Produced Identification
Type of Id ti l tion
Type of Identification
Produced
-Produced
=ootaryPubhc State of Fiorillo
Matthew LeStarge
y < dMy commission OG 205104
Expires 04/09/2022
row° Notary Public State o Florida
(Signature o o a
(Signature of N 6�1i-t16f@'P�Btmi�Rosls4
o„xo 'puss oaroerzoz2
Commission No. (Seal)
Commission No.
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SUPERVISOR
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DATE
COMPLETED
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