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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Nu
Date:
te �«
9 2020Building
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Permit Applicag t)artment
Planning and Development Services e C I nty, FL
Building and Co de Regulation Division Commercial Residentfai
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: k7 &--o a,+; a jr).
Address: Q 1 J n l pS
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�T� ~ ��y� O�� �vLot No.
Property Tax ID#:
Site Plan Name: Block No.
Project Name:
;DETAILED !}ESGRIPTIO(d OF'WOI2K ';;
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Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Pi ping _Shutters Windows/Doors _Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ [ > i Utilities: _Sewer _Septic Building Height:
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Name (�ii / �I f
Name:
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Address: J lzw • 'Q G) r Dot .
Company:
City: aZ T. 1r P St�_
Address:
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Zip Code: ��`g _, . Fax:
City: State:_
Phone No. 5 7� . �;j Z(F • 9))
Zip Code: Fax:
E-Mail: ) 1
Phone No
Fill in fee simple Title Holder on next 6ge (f di L44n •
E-Mail
from -the Owner listed above)
State or County License
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If valu of onstruction is 2500 or mor a RECORDED Notice of Commencement is required.
If value o HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
OWNER/ CONTRACTOR AF.FIDVIT: Application is' hereby made to obtaiwa'peimit 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 tFiat is granting'a permit will authorize the permit holderto 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 imthe 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 attorneybefore commencingwork or recordingour Notice of Commencement.
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MORTGAGE COMPANY: _Not Applicable . �.
_Name:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
Address: •
City:
Zip: Phone
State:
City: 'State:
Zip: Phone:.
FEE SIMPLE TITLE HOLDER:
Name:
_Not Applicable
BONDING COMPANY: _Not Applicable
Name: '
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
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 _day of . 20_ by
this _day of 20_ 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
Produced
(Signature of Notary Public- State of Florida) .
(Signature of Notary Public-$tate�,of Florida) ,
Commission No. (Seal)
Commission No
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA -TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW.'
REVIEW
REVIEW
DATE
RECEIVED
'
DATE
,
COMPLETED
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,�,ry
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