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All APPLICABLE INFO MUST BE COMPLEti,tu iOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Appli
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:
-PROPOSED IMPROVEMENT LOCATION:
Address: 5-30'7 01.6AK we— Aklg-.17. 1 eam- R. 34,7ez
ion RECEIVED
OCT 212019
ST. Lucie Cou
PropertyTax ID #: 3401^ Bob -Cool Lot No.
Site Plan Name: Block No.
Project Name: LC Ib
DETAILED DESCRIPTION OF WORK:
A IQ' 5 '54
1i SIt) e-
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $" MCI—
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height: 1
OWNER/LESSEE: „ "
CONTRACTOR:
Name EOL41L,
Address:
.� lob
City: 1. P84ALkr State:
Name:M I L
F a 4--
Company: 1 I47 4, ����� Gtl� c7 c'S �.
Address: 966 Ar 1 �A S
Zip Code: AU'Z Fax: 77Z'��2- Q1�
Phone No. '7 7 Z - Wi' 16
E-Mail: a WL OLcl - & 4-0 1- : Ca1'►r)
,�
City: I dP State; lT!• _
Zip Code: z Fax: %72 02 - -(S
Phone No `% 72 - 2 4! 1TJO
Fill in fee simple Title Holder on next page (if different
E-Mail P�j �%� L • ���
from the Owner listed above)
State or County License G g L o3 oq 3s .---
If value of construction is 52500 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.
SUPPLEIViENTAL CONSTRUCTIO EN LAIN INFORIVIATIO.N:.5
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
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: 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOM LENDER O"N ATfbRNEY BEFORE RECORDING YOUR NOTICE OF-COMMMCkMENT.
Signature of Own
as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA z!::�L �y STATE OF FLORIDA� I ,�
COUNTY OF �.1 f 1 �I�l _I`e COUNTY OF
The forgoing instru
en w s acknowledge efore me
this�L day of
�-V-K I I
1 by
LaoI,d1Q
Name of person making statement.
Personally Known OR Produced Identification
Type of Iden ' icati • n ,, ,,, ,� 1
Produced L_ �L (�.� 1'-,`
W
(Signatur _a
W COMMISSION # GG 160769
Commissi .ember MAN 1)
:'�FGF G ��P•• W d¢d ThN WtW PING Uklellftl
REVIEWS I FRONT I ZONING
COUNTER REVIEW
RECEIVED
DATE
COMPLETED
The for oin instru en was ^ a^ck•nowled a before me
this d y of 2T , 20)Z by
a' U 13
Name of person making statement. %
Personally Known OR Produced Identification
Type of Identificati n i
Produced a L- 1 � n
WCOMMISSION#GG160269 (Seal)
Borded Thru Notary Public Underwriters
SUPERVISOR PLANS VEGETATION I SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW