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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: ZDbG - 0131
Date:
Application
Building Permit
Planning and Development Services /
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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Address: 4490 / 4&IJ74S c� " ar��e�f2��lne rn
Property Tax ID #: / Lot No.
Site Plan Name: Block No.
Project Name !-Ower�i Q�r4I �r PMnd��
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New electrical Meter Second Electrical Meter
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Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters /Windows/Doors _Pond
_Electric Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction:-6+617!J?4 Sq. Ft. of First Floor: -6n(U
Cost of Construction: $ "'a el'a . 00 Utilities: -X Sewer _Septic Building Height:
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Name ZA YV Name:
Address:A9Q1 r-,-ot,t/ct$ 46 Company:
city: �F g r= ed L p, State: F/- Address:
Zip Code: 4 9s/ Fax: City: State:_
Phone No.72 - / - sl( Zip Code: Fax:.
E-Mail: %Arlt I 11v 2/`-IPhone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) 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.
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DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
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 accordancewith 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 attorneybefore commencingwork or recordin our Notice of Commencement.
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Signature of Ow r/ Lessee/Co r dor 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
Presence or Online Notarization
Physical Presence or— Online Notarization
-QPhysical
This t day of a, A r s 20,tby
C A-\
this _ day of 20_ by
Name of person makinif statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known' < OR Produced Identification
Type of Identification
Type of Identification .
Produced O L
Produced
fir.
(Signature of Notary Pub is -State of Florida) .
(Signature of Notary Public- State 'of Florida )
Com ssr. U
Commission No. (Seal)
t,_State of Florida -Notary Public
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My Commission
Expires
-
REAMS""-`"
SUPERVISOR
PLANS
VEGETATION.
SEATURTLE, :
MANGROVE
REVIEW.
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE.
COMPLETED
Rev. S/b/20