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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTIr_
Date:
l
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Permit Number: kZjd1" 0 3 C;!—
—REC;IMIVE®
Building Permit Applicati n AUG 19 2020
ST. Lucie County, Permitting
Property Tax ID #: �� L�� ' d t� e-9 Lot No.
Site Plan Name: Block No.
Project Name: D
Setbacks Front, cji` Back: 9-U I Right Side: I�O� Left Side: 1I �,
147-1 C) i
r
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric Nobmbi//ng _ Sprinklers _ Generator
Total Sq. Ft of Construction: l 9 �.Sq. Ft. of First Floor:
Cost of Construction: $. `-�` , 7 Utilities: —Sewer —Septic
Name J
Address• � 1�
City. StateV9
Zip Code: E- Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Company:
Address
— Roof
Building Height:
02
City:1'T 4 I if e �_ ' I Stater
Zip Code:,3 !1 Fax:
Phone No X7 0
E-Mail D d
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
NEER:
Nam
Addy
City:
Zip:(
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
J)eh. Address:
State: City: State:
Zip: Phone:
i
Not Applicable BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
�nmt-nnnr•ina vernri[ ry rarnrriina wmir KIntira of rnmmenrement_
Signature of er/ Agent/ Lessee/Contractor
Signature of Contractor/License Holder
STATE OF FLO /,
STATE OF FLORID
Z. �
COUNTY OF
,/
COUNTY OF
The f r oing instru nt wa acknowledged before me
The f9 ,ping instruprient was acknowledged before me
day 20— by
this ZQ day of 20;0 by
this/f-/ of
ame o erson ackno edging)
e of erson acknowle ging )
4,(Sk'nature
ture of tary Pu lic- State of Florida)
of N tary Public- tate of Florida )
Q
Personally
K own OR Produced Identification T
Personally Known OR Produced Identification
Type of Identifica '
�.�
Type of Identification
Produced
Produced
Y� SHERRIFEHL
MAN�Pvr
_
Commission�fission # GG 187160
.No.
*
4ftsion # GG 187160,a
Commission No. Nr�
yplBondd
xpiressMarch.14,2022
Budget Notary
Bonded
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DATE
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COMPLETED
Kev. //2614