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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
CaA%-Son
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
"tip
ion MAY 112020
Peirmitting IDepartmeln
St. Lucif�Ceunty, I=L
J PERMITTYPE: S1WGLf i-k%kIL`I (LESI REAM /
PROPOSED IMPROVEMENT LOCATION: /
Address: 524,2 SLASR 60- F021- P►g& I FL, ';4951
Property Tax ID #: I �-10"I - fj�l 3 — OO 2_!�— DOO" rf Lot No.
Site Plan Name: Block No.
Project Name: 65-1-L, (%F-S I'bF--VI-CIE_
DETAILED DESCRIPTION OF WORK:
6WL:t:-lvk& A M 51WU11 RTAA(A NmE
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping J Shutters Windows/Doors
Electric JPlumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: JD Orl Sq. Ft. of First Flo r:
n i Ir
Cost of Construction: $ ar 16, DOD, Utilities: —Sewer Septic Building Height: i
OWNER/LESSEE:
CONTRACTOR:
Name i4. -r(Drt Awl NM-'fA
Name: a-► 0 6LUL1hlVLG CO2
.
Address: 57a0 WESrgIf LJ W,
Company:�
WA
City: nt-Li' )so State: FL
Zip Code: 595I0 Fax:
Phone No. RI07 - 611 oiCDoZ
Address: 7igq SF�YISFI/}tit PL,yb.
City: �)54!AJi10 State:-Lt.-
Zip Code: Dqs% Fax: 177J_5%9- 59K3
Phone No r7 rra 5 - 9- S 9
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail a YJ0 0 i o e a015 (a_ A W I • COM
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.
SUPPLEMENTAL CONSTRUCTION LIEN'LAW-INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: 604 KPOLFU
MORTGAGE COMPANY:
Name: (�,FJfITF� 570.5�
Not Applicable
Address: FLAMAao IZ
1
Address: a U CAif 111A1
City: jet VI UAa State: FJ
Zip: 32904 Phone
City: \I ULO 15 (N
Zip: U963_Phone: 712-R59-R579
State: _r:J_
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable
Name:
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 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE ECORDED AND
POSTED ON THE JOB-5RE BEFORE THE FIRST INSPECTION. IF YOU INTENDD7TO OBTAIN FINING, CONSULT
_
WITH YOUR ER O AN ATTORNEY BEFORE RECORDING YOU9 NOTICE O COMMENCEMEppNT"
LI-Z
s Agent for Owner
Signature ner esZ'e
Signature Con acto cen er
STATE OF FLORIDA
COUNTY
STATE OF FL 1
f
OF
COUNTY OF
A
The forgoing instru en as acknowledged before me
The forgoing in me t was acknowledged before me
this � day of 20�by
th day of 2�by
No alrD N f Cl-UJ 0-
Jessica M. Papczynski
Name of person making statement.
of person making st ement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
P uced
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