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ALL APPL INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEI`'rD SEP 19 7017 - -
Building Permit Ap licatibn
Planning and Development Services �r� 'I
Building and Code Regulation Division u
2300 Virginia Avenue,Fort Pierce FL 34982
-- Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVE ENT LOC ION:
Address: I vA h 3 q-y K-?-
Legal Descripti A.
e one- on i
Property Tax ID#: — Lot No.
Site Plan Name: Block No.
Project Name: S i1 C tWif
Setbacks Fron Back: Right Side: 17 Left Side:
DETAILED DES P ION OF WORK:
tons+kiL niiq e sin l s I� J cstleme
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CONSTRUCTION INFORMATION:
Acid itiona I work to e e orme under this permit—check a apply:
rVAC
Gas Tank Gas Piping Shutters Windows/Doors
lectric 9—Plumbing Sprin rs Generator Roof Roof pitch
Total Sq. Ft of Construction: 3Q-7SIC Ft.of First Floor: 3
Cost of Construction: .Utilities: Sewer[4 Septic Building Height:
OWNER LESS E: CONTRA OR:
Name Name: 1 Ir
Addre ff n-Ay UCompany:
City: 111li 'State - Addres +1/
Zip Co e: /Fax: _�r�' City: , Stat
Phone No. 7� L ' �� /.�� Zip Code: ax:
E-Mail: er4iiviot.
om Phone No. ..
Fill in fee simple Title Holde or n next page(if different E-Mail: SO
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from the Owner listed above) State or County Licens
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN /ENGI Not Applicable MORTGA COMPANY _ of Applicable
Nam IPIr Name:
Address: Addres .
City. tat City Sta e: A
Zip: Phone — Zip Phone: -- It
FEE SIMPLE TITLE BOLDER: of Applicable BONDING COMRA(Iy:: Not Applicable
Name: Name: =E:L13
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 Not!ce of Commencement ement may result in your paying twice for
improvements your p operty.A Notice of Corpmencement must be ecorc� d and posted on the jobsite
before the first in ti n. If you intend to obtain financing,consult w' erg er or an attorney before
commencing wor r cordin our Notice of ommencement. /
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Signature ne ee/Contractor as Ag r-Awn tgnature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S V. 1,oc ek COUNTYOF 6k, LUc�e
The forgoing instrument was acknowled a before me The for oing instrument was acknowledged before me
this day of Sc .201-1 by this � day of 5 ps ,20�1 by
AsC,1n qc\ble-c SJS�r $acne C
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced A-D L
(Signature of No cgubli Sta (Signature of N .r (lfi>xc-States rJ,_�j,�11GIVENS
L7C�INNA MARIE GIVENS �c (1� A1Y COMPdISSION#GG 022023
Commission Nod '. 41 OA1rd!SSi 6E 022023 �!' ^ -
Commission No. :°t7� FIRES:Dece(g���2020
EXPIRES:December 16,2020 Thru Notary public Undenvrifiers
Donded Thni Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE `
RECEIVED 11
DATE
COMPLETED
Rev.8/2/17
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