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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 � �' Permit Number: 1203—023
Building pp Permit Application I
Planning and Development Services MAR C-'4
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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:
P'R®POSED INPRC}Vf MENT LOCAI'10,
Address: . D�j
q1x_T 1 C'< 2 &
Legal Description: "0#0/) L &4')1T , 6 1'< � VI i &k/\J op-
Property Tax ID#: / L) ) - UDY ' U )31 - 66od, Lot No.
Site Plan Name: Block No.
Project Name: ! VPL/�
Setbacks Front Back: Right Side: Left Side:
DETAILED DE=SCR(PTION OF WORK:
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CONSTR+(:1CTtO'N GN�FO �+MATtON:
itiona wor to a pertorme un er t is permit-Check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof �) Pitch
Total Sq. Ft of Construction: 11 -7 00 -Sq. Ft. of First Floor:
Cost of Construction: $ my. ~ Utilities: —Sewer —Septic Building Height:
OWNER/LE�S�SE , ,RC*,O:NTR�AC�T�aR: �,
Name �r Y >` L 1 G Name:
Address: 0 D. . - I04- Company:, &
City: 'T ,,II 1 c'C�.� State:�, Addre s:
Zip Code: 3�T��� Fax City: e State- J
Phone No r7?L` _3�I - 3 D 3 3 Zip Code: Fax: -77��57.Lt bfgyJ
E-Mail: mon oo'PCIST) '() Phone No ' 1 --4/7D ' 7 P
Fill in fee simple itle Holder on next page(if different E-Mail e rum 11 •Com
from.the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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StJPP'LE(1IIEN1"ALC�N6-TRU'C I®N LIEN LAVA IN RN,ANT] N:
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 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 of Owner/Lessee/ nt ctor as Agent for Owner Si re of Contractor/License Holder
STATE OF FLO DA nn STATE OF FLOR A
COUNTY OF �� �a'ye� COUNTY OF
The fo going instr nt was acknowledge before me The for of g inst nt was acknowledge/dpefore me
this �� day of 20L by this for
of '��Y 20_ by
bfihl) 116 AJ
(Name of person acknowledging) (Name of person acknowledging)
(Signat r of Notary Public-State of Florida ) (Signature f Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Know
Type of IdIn _ Type of Identifica g ,"""° MARGUERIT:EETOCK
YPa�i5i+fji's MAROUERt1-EM.ESTOCK Produced MY COMMISSI238495
Produced EX
,2019
*: FF238495 'FBonded Thru Notarnde 'ters
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NotaryPubl rs Commission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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