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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -
Date:�a.'2'aa Permit Number:
ST. LUCIE
Building Permit Appl
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
4 r�� Sine
JUN 2 8 2020
ST. Lucie County, Permitting
Residential
Address: 10'7U/ /_�L_� t'7 l"! / v tdW11-f
Property TaX hD #: Lot No.t(o
Site Plan Name: 6lfE /7 Block No. 1-49_
Project Name:
DETAILED DESCRIPTION OF WORK:
"dN x-;�
New Electrical Meter
CONSTRUCTION INFORMATION:
Electrical Meter
Additional work to be performed under this permit- check all that apply: Ai /A
Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors _ Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:Sq. Ft. of First Floor:
Cost of Construction: $ l Utilities: _Sewer _Septic Buildingl-leight:
OWNERAESSEE:
CONTRACTOR:
Name s i b 1 N A.
Name: N
Address: laq0t
Company:
City: IF
Zip Code: . Fax:
Phone No.
State:
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: OW L/W . ACr
Fill in fee simple Title Holder-on-ne)d page ( if different
from 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 HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLE.MENTALCONSTRUCTION LIEN LAW INFORMATION.:
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _NotApplicaple
Name:
Address:
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 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
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender, or an attorney before commencine work or recordine vour Notice of Commencement_
449LAM f I'-
P7n"
,SikfiaTure of Owner/ Lessee/tractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA ��C/
STATE O FLORIDA
COUNTY OF S;I
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 I"1 day of iUr\.� 2020 by
zC\Ciitement
this _ day of 2020 by
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 �rw2r cPr
Produced
(Signature of Notary Public- State
) MISTYDAWNW
igna
re of Notary Public -State of Florida )
Commission No. Cac�`1C)
s�� .,; MYCOMMISSION/
;? rl) EXPIRES:JaaueryB
'•.�oif�$t"
945470
2Q�mm
sion No. (Seal)
BoMedThmRO�y PuCIbU
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
•REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
z
DATE
COMPLETED
Kev. 516/20
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