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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -�" ) ) • a-'Q Permit Num
Building Permit Appl
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:
Address:
rA
10
FEB 1 1 2020
:ion
ermitting Department
St. Lucie Coyinty, FL
Residential
Property Tax ID a: •Q 412 '3 - 66/- Od 6 O - O a O 10 Lot No. / 3 /
Site Plan Name:
Project Name: 2.cJih�spy� o�
Additlipnal work to be performed underthis permit— check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric /Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction:
Cost of Construction: $ -;j�r O U
Sq. Ft. of First Floor:_
Utilities: Sewer _Septic
Block No.
Windows/Doors
Roof Pitch
Building Height:
e- E SEE:
GONTRACM —
Name S✓a6,n i w IZe Y�GS
Name: /' G-'9(? Ze
1 I
Address: G9/6 A)0 adyn" A.y Sf
CompanyzC+f/,.,lm IS
City: �iiyt S �. �u Gi'e State:
Zip Code: JJ �/ 9 S.3 Fax:
Phone No. S z2 ?2Z - 6,6 Q -2
Address: /� L�1inW��wU
City: �or7f A e/CC,
Zip Code:Y4i982
Phone No
Fax:
Stater
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail NazelG/a • p /4
gY
Gig l'/•Ceres
State or County License ?HZ//23
/ 36
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.
DESIGN ER/E/NGINEER: " _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: .`J n ,.,gn se/
Name:
Address: 9�i 0 Z /ems.
Address:
City: pv? G✓c e� State:
City: State:
Zip: Phone 92 51•32
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Applicationis 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 Counri 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 an 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 afull 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 f 0 ner/ see/Contractor as Agent for Owner
SignaturKofR6 ra r/License Hold
STATE OF FLORIDA
STATE OF FLO
COUNTY OF�_`/%
COUNTY OF
The forgoing instrum nt was acknowledged before me
this _ day of i �, �i 20�V by
Thefor oing instrum was acknowledged before me
this �/ day of J 20�by
62t-rne 2�e�
��h� g WU
Name of person making state nt.
Name of person making statefnerl .
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identification t�
Produced ��'yOLCl 5"1Pvkz-L
Type of Identification
Produced
(Signature of to
Commission No.
IiiibiiGrS
(Signature of
Al1DR6YB.HUMPHREY
Commission. N fit : :4 MYCOMMISSION#06f7
q?y' . Nr: IRES: M'earrcchh 61, 2.D2.3.r1-_
h.l..� Bu.n.Wth�aN.nu, PUDGCtNNe�lleia
,• ADDREYB.H dPHREY
@ DOMMim"m3MIT
ate• p= EXPIRES: March 6; 2023
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.