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APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date:
6 �) Permit'Number: ��G
� EI`)1,_,,
RECEIVED
Q �! JAN 2 ® 2021
Building Permit Application Permitting Department
Planning and Development Services St. Lucie County/
Building and Code Regulation Division Commercial Residential 11
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
-Address: 700 S �?1 -
Property Tax ID#: 30 —�6i 11-40y�-OaQ- Lot No.
Site Plan Name: Block No.
Project Name:
YDEi4 L D� S "I i
k, E
2�0 �rtl / OC Mai 1�' '
XZ&ry S/l'- ,/lug 4`a lke3t4 &v*( S V ea.�ti2Q ^
New Electrical Meter Second Electrical Meter
,wry F R AT�I O N
Additional work to be performed under this permit—check all that apply:
_Mechanical Gas Tank _Gas Piping _Shutters "_Windows/Doors / Pond
_Electric _Plumbing ,Sprinklers ' _Generator tch;
Total Sq. Ft of Construction: � G Sq. Ft. of First Floor:
Cost of Construction: $ /`� �b7b Utilities: -Sewer _Septic Building Height: �d
nxy,..c Svcs .+,�.- - � i,�' r tts•,; t��.'��ratnx t.-`�, - ..� ��,�ya*r, .c2r._ i
yOWNE'R LESSE
c�:.4+T�c�'.-.c�?td.,c*z:"r.7.�1P_:..fir-��Cr.'�S�����.'' w`43.,. .4.. a�6 .W '..v1f��iz� .���'�..i -�;_!9'.r, '`'i .y.w•S4$��.A`� � JM�'"
Name Xe,,, [iPi g±1± &'oy-zl Name:
Address: �c.�ilis� u - Company: J&
City: /Oh ii,-, �! State: 4'1� • Address: o'LO
j Zip Code: 3 Fax: city• ltiy_ Stater
Phone No. 7>1 Zip Code: J�� 7Y/ Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County ricense 4-
C -3
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.
i
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'l 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 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
with lender or ttorne before commencin work or recording our Notice of Commencement.
Signature Owner/Lessee/Contractor as Agent for Owner Signatur of Contractor/License Holder
STAT F FLORIDA STA E OF FLORIDA
COU OF S . L y c��. COUNTY OF ��• L����
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
—Physical Presence or Online Notarization Physical Presence or Online Notarization
this'�,6 day of 5g n 202q by thisa O day of 'Yq Y1 202k by
Name of person making statement. Name of person ma ing statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced \., 0 L. Produced1--
(Signature of Nol6ty Public-State of Florida j - (Signature
tYFce, AUDREY B.HUI�JIPH EY
'o O MY COMMISSION#G'5� 17
Commission' o ....., _pimRr_YB.HUMl55t;4a7� CommissionIr
?` MY COMMISSION#GG 300817 ��. �XPiRES:March 6,2023
r_c•>;: 73yTWinry Public Undenvriter^.s•.,�ar.f.'S�Zt6si5^. ..
' Bonded Th u 1. +;vkvic under rrifors
REVIEWS ' "'. ``fufi ��zONt `SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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