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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ``nn ��/'7{,
Date: fr/ .�Z Permit Number. � V \L 0V / V
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° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential r/
2300 Virginia Avenue,Fort pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: I
Address: �7 �0�ZI �.S�U ✓1 S e/.,r�"{�/
Property Tax ID#: 7 U -a. t0 os- t2 rf1% 4-'0000 Lot No.
Site Plan Name: 72T_ cA C{k CJ Block No.
Project Name:
eMqp E ISTIH A 0 in Ff 7n ou1S 1 }ti eoL)
New Electrical Meter Second Electrical Meter
a
Additional work to be performed underthis permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters ✓windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 2 c1-017' a� Utilities: _Sewer —Septic Building Height:
Name QU A)I -5-L4 CQ Name:s CI C- L r FR
Address: 2-02 5-I-/v15,e+ Zi V D � Company: L 7;1
City: H• State: F114 Address: 4:?/- W ' ! e! e-
Zip Code: Fax: City: 9(1 c-tC State:-E(&
Phone NO.-712, Zip Code: 2.1.}qS'3 Fax: 772-773-7-3/!
E-Mail: Phone No'77
Fill in fee simple Title Holder on next page (if different E-Mail IS'Z e doj I Y T erS 2 G m w�•!_o rr7
from the Owner listed above) State or County License C dC
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:
Address: Address:
City: State:i 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 roams and accessory uses to another non-resiciemial use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
/wiiJth lender or an attorney .b(efforre commencin work or rrreeeccordin our No�ti"of
Commencement,
Signature Signature of Owner/Lessee/contractor as Agentfor Owner Signature of Contract.r/LicerseuFulder
STATE OF FLORIDA e� I , , STATE OF COUNTY OFORIDA S� I^ LL J
COUNTY OF lJ l�l
Sworn to for affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
PF� cal Pre,t yr Online Notarization Physical Presenc [1 _Online Notarization
this_7day of N✓t/ .20120 by this�day of IN_� 2020 by
Name of person making statemen . Name of person making sty aterri
Personally Known`OR Produced Identification Personally Known_OR Produced Identification
Type of Identification Type of Identificati¢¢n....
Produced Produced Ir—
(Signature of Notary Public-S at (Signature of Notary Public-S to of Florida)
Commissio NgJ :U'-, ELLENa No{ ,blic Commission No. LLEN HN
=_ Commission tt GG 2]na]9 a=stele or Florida-Notary Public
ommission Expires = Com
Oc a sr 44 ivy Commission xpires
REVIEWS SUPERVISOR PLANS VE 00ANG VE
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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