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All APPLICABLE INFO MUST BEz COMPLETED FOR APPLICATION TO BE ACCEPTED
r ow Date:
Permit Number:;D_n I� p,�) 6
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�. c 'I t Build
iing Permit Application.
Planning and Development Services
Building and Code Regulation Division Commercial Re"sidential
2„300:Virginia Avenue,Fort Pierce FL 34982-
Phone:(772).462-1553. Fax,(772)"462-1578
PERMIT APPLICATION.FOR
PRC3PC3S�D��MPROVEIVIENT
Address: Sq S w 3 x
f
Property Tax lD##: / SOa - of q6 - ovo- Lot No. a
Site Plan Name: '10rn e5- S=1aY' Block No.
Project Name: Dim�S 5blou(
7,77
f�ETAILEQ DESCRi PTtON OF 11►tORKF
r.
Vk 7 •TZ
New Electrical Meter Second Electrical Meter
z
CONSTRUCTION CNFOR(VtATION°
Additional work to be performed under this permit-check all that,-apply:
_Mechanical _Gas-Tank _Gas Piping _Shutters —Windows/Doors Pond
x Electric _Plumbing _Sprinklers Generator Roof `Pitch
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ _2�,'rj12 Utilities Sewer _Septic Building.Height:
OWNER/LESSEE°
._
ONTRACTOR
Name-- tbCtnJ 7G o 5 Name:
Address:�19 lu S_ 5�2 a')t•q
l2 I'l X f' Company: 5tu ;22 G6f
City: State: P// Address: Y° j
Zip Code: .�w
4C` S l Fax: City State:
Phone No. -/7:.2 - L1 s 3 -- R 3(- ID Zip Code: Fax
E-Mail: Phone No
Fill in.fee simple Title Holder on next page,(if different E Mail I ".UG
from the Owner listed above) State or County License ]
'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.
MllPRUMENT7A-` CECO V T�UCTTtli TE 1 LAW TN QT�1 8 TTt TV � . ;
F.Y" ,.,.a..:.� a..:_a.x,k._ .- 3.sa o- _b ,. w; <, en a;. a :F- x� .1.:. ✓o.F•"& f 'ti, �'
DESIGNERf ENGINEER ; Not,Applicable MORTGAGEOMPAI�Y: Not Applicable x
Name:,. ...
'Name:,
Address. Address:
-
City State: City: State'
Zip: Phone Zip Phone:
:FEE SIMPLE TITLE HOLDER.; - Not Applicable BONDING iVCIMPANY:" Ivot Applicable
Name. Name:
.Address. Address:
Clty:
City.
Zip Phone:.,
n Zip Phone:
OWNER/CONTRACTOR AFFIDVIT:Appl"ication 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 apermit.
5t.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 l will;in all re spec ts,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exerript;from undergoing a full concurrency review:room additions,
accessory structures,swimming pools fences walls,signs,screen rooms and accessory r uses to another non-residential,use:
WARNING TO OWNER:Your'#allure 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,befare the first i', spection.-If you intend to obtain,financing;consult
with fender or an attorneV before commencing work'or'recordin our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder'
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF. COUNTY OF a.
P 5r
rn to(or affirmed}and subscribed before me of Sworn to(or affirmed)and subscribed before me of
PhicalPresence or Online Notarization Physical Presence or Online Notarization
this /Of day of 2020 by this 2,,.&day of bCtcbel 2020 by
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a e of person making statement. Narne.of person making statement. a"
y C
onally Known OR Produced Identification Personally Known �`' OR Produced Identification Q r -
of ldenti a 'on Type.of Identification
Q
uced Produced '°"'
Z LU
i ature,of NotaryPu lic tate of Florida
Q
) (Signature.of Notary Public-State of Florida)
mission No !'T�I��3qJ� (Seal) Commissions 6,C;Qa )1 s` (SeaI
REVIEWS FRONT. ZONING SUPERVISOR PLANS VEGETATION SEA.TURTLE MANGROVE
COUNTER REVIEW REVIEW: REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED ..
DATE
COMPLETED
Rev