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All APPLICABLE INFO MUST BE COMPLETEu"r4OR APPLICATION TO BE ACCEPTED
DatePermit Number: k1 03�OGG
G
ra
RECEIVED NAR p w 2017
. _�.. _ 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
PERMIT APPLICATION FOR:
PRgP®ED IN ,ROUEME'NT LOCA I:ON:
Address: 4e
Legal Description: �f�-
Property Tax ID#: Z151 4]006 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
'E AkLED DF�S,C. I'P L® O: OR
CO`NS�21 TIGThON I F®RMA�TION.
m
Additionalwork to be pe orme un er t�is permit-c ec a t at app y:
Mechanical _Gas Tank _Gas Piping _Shutters 11Uind'ows/D6ors
%--Eiectrfc plumbing =Sprinklers —.Generator Roof
Total Sq. Ft of Construction: J Sq. Ft.of First Floor: l_
Cost of Construction:$ /L'OZi LSO j'd Utilities: _Sewer —Septic Building Height:
0\ll{! EIR/LESEE� CO-NTRAGOR:
Name.I ',+ Name:
Address: 21 .. AV Company:'
City:_f%�lh `, _ ��� %�., q �Q. State:FL Address:- : ;'` ` d W
Zip Code: 3'22 53 D= Fax: City: State:
Phone No. 37, 9;7� / Zip Code:
69,j Fax: /. 76. yZ�i
r
E-Mail: i 1/7 jQ4 7 X9,0, l' rx) Phone No 60/
Fill in fee simple Title Holder on next page(if different E-Mail ble/J ii R�L�arls7✓r���;cr.� t�/.►7RL'
from the Owner listed above) State or County License 61,7C- -6Z 593 O
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPiEMENTAL CONS CTI'®N LIN, LAW I�NtiA®;R�IUTATlON:
DESIGNER/ENGINEER- _Not Applicab . MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: r StateCity: State:
Zip: �, Phone -7 2 Tom_ -7- q2_6A Zip: Phone:
FEE SIMPLE TITLE HOLDER: of 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 thepermit 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.
Signature Owner/Lessee/QontpWr as Agent for Owner Signaturo-
f Contractor/License d r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S)r.. COUNTY OF.. 5)r.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2, day of r,-^-C. 20AI_ by this 'c?, day of h'%a►i ,201J by
�v � o,r�, 'Lee.,n d�•4- �Cy o r Le v.o-�.
(Name of person acknowledging) (Name of i5erson acknowledging)
(Signature of Notary blic-State of Florida) (Signature of Notar - ublic-State of Florida)
Personally Known OR Produced Identificatiorr—"�) Personally Known OR Produced Identification—A'
Type of Identification ype of Identification
Produced L V DNpMpR1EGNENS roduced �-
y'°j+"4••, MISSION#GG022023 ;=Q.• - s! �,NI�E�,G�jI�'VENS ,
�,' o• MY
COMMIE
Puke(llnderwri y C RES•I Dederll5�}r-T 022023
Commission.No. �5 "_ ( i1�t Decem t rs mmission No.
otary ,F P 6,2020
c Bonded Thni N I „o���,•• Bonded Thm Notary Public Undenvaters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE- MANGROVE
COUNTER REVIEW _REVIEW REVIEW REVIEW REVIEW REVIEW
DATE .,
RECEIVED
DATE
COMPLETED
ev. -b)MCIL;'