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ALL APPLICABLE INFO MUST BE COMPLEA FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number:
RECEI -D JAN 117917
Building Permit Application
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 Residential _
I -
P'ERMIT APPLICATION FOR: P `
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11
PROPOSED IMPROVEMENT LOCATION-
.
Address: S
Legal Description: TrA v,
Property Tax ID#: 1 2>01` �`030- QW0-I Lot No. _
Site Plan Name:_ __ _/ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:`DESCRIPTION OF WORK
CONSTRUCTION INFORMATION:
A itiona wor to e e orme under this permit-check cheEk all app y:
11HVAC 17!Gas Tank ❑Gas Piping _Shutters Windows/Doors
10 Electric 0 Plumbing Sprinklers E Generator 16 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ I a Q Utilities:]Sewer E]Septic Building Height:
. MANE -'/L-ESSEE ,' n„ ``` _ `CONTRACTOR
Name_ V1 Name: a
Address: Company:
City: State:, Address:
Zip Code: P Fax: City: M StateEL
Phone No. Zip Code: aaHIE _ Fax:
E-Mail: Phone No. S g ` + QI
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: PQ.0S_7 q 33
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR'UCTIO N�LAW.INFORMATION: ,
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:
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
commencing work or recording our Notice of Commencement.
s
ignature of Owner ssee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA - STATE OF FLORIDA 4
COUNTY OF—Ma( COUNTY OF
The fo ing instr ment was acknowledged..��yefore me The forgoing instr ment was acknowledged before me
this day of c 'l,(. 20 �1 by this j��day of 20 rl by
�A q(M S'i�M
(Name of person acknowledge g) (Name of person acknowledging)
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i
(Signature of Notary Public-State of Florida) (Signdture of Notary Public-State of F orida)
Personally Known OR P oduced Identifcation Personally Known OR Produced Identification
Type of Identification Produced � Type of Identific 'o r
V �4� Notary Public State g FloWa
Commission No. (Seal) Commission No. `f+ -LeAhDenlse gaq(Jeal)
My Commission GG 036768
os Expires 10/08/2020
NC4
Revised 07/15/2014 �, "" Notary Public State of Florida
Leah Denise Ball
1 . M Commission GG 036768
a r E pines 10/06/2020
REVIEWS FRONT 117' S VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS ��