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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:. Permit Number:
Building Permit Application
Planning and Development Services
Building,and Code Regulation Division Commercial Residential 4,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1518 0
PERMIT APPLICATION FOR:
Address: SS 14 p0z"e- .
Property Tax ID #: Lot No. _
Site Plan Name: Block No.
Project Name:
10
Im
New electrical Meter Second Electrical Meter
Additional work to be performed under this permit - check all that apply: "
_Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors Pond
iY7
_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of.Construction: $
Sq. Ft. of First Floor:
Utilities: _Sewer Septic
Building Height:
Name_ (' q� (it2r��tP ��o (-(-�[ Name:_ C'.1� 0. ii 2 Ce-o 0 eel
Address:j`S/ U . iirr �. Del v� Company: r(p
City: fo r e -e ra Stater s Address:.
Zip Code: _3 y 9R 2- Fax: City: State:
Phone No.)`% Zip Code: Fax:
E-Mail: S ('>`Z Yes- artct,; + Go/V 1 Phone No QkS 9 6
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License ElordA
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.,
DESIGNER%ENGINEER: Not Applicable . MORTGAGE COMPANY: _Not Applicable
Name:
Name: x.(GeliJi z.�-J b cx.^ '� vi �.'
Address: Address:
City:
State: City I State ,
Zip; Phone Zip Phone:
✓Not Applicable
IY: PP
FEE SIMPLE TITLE HOLDER: Not Applicable . BONDING COMPANY:.
_.
Name:.,- :-
-
Address:
Address:
City: City:
Zip•
Zip; Phone: Phone:
'
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit toL do the work and installation.as indicated.
I'.certify that rowork or iristallation.has commenced `rior to the issuance of a permit
p ;. p' '
p p :bylaws or f6i er it older to build the sub3ect structure
St. Lucie Counttyy makes no re resentation that is; granting a ermit will.authonze the ermit ants that may restrict or prohibit such
which is in.conflict with any, _applicable Home Owners Association rules,
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,;) do hereby agree that I will,;n-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
1 y result jn. paying twice for
WARNING TO.'OWNER: Your failureto Record;a Notice of Commencement ma
Lucie County t nd posted P
A Notice of Commencement musfi'be' r,'eco ded, in the public records. of St.. .
Y.
ro -e
d on the lobsite before the, first'inspection. If you intend to, obtain financing, consult,
with lender or an, attorneybefore commencingwork or'recordin .our Notice of Commencefnent.
Signature of owner/ Lessee Contractor asp Agent`for Owner
STATE OF FLORIDA
COUNTYOF Ste.+ n
Sworn to. (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this LL day of C e* n ±Lnalk / 20 ?-6 by
Name.of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
of Notary
Commission No. = YcoNiWd9ft # GG 275060
I '; ;ae; EXPIRES: December 20, 2022
REVIEWS I COUNTEFRONT RI. ZONING
W I, S REVIEW
DATE
RECEIVED
DATE
COMPLETED _
Signature of Contractor/LicenseHolder
STATE OF FLORIDA
'COUNTY OF I -:
Sworn to (or affirrrk med) and subscribed' before �me of
Physical Presence or Online Notarization'
this day of 120_ by
Name of person making statement.
personally Known OR Produced Identification
Type 'of Identification
(Signature of Notary Public- State of Florida )
Commission. No. (Seal) .
PLANS
VEGETATION
SEATURTLE
MANGROVE
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