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All APPLICABLE INFO MUST BE COMiy ED FOR APPLICATION TO BE ACCEPTED NW
Date: Permit Number: F709 -
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■ Building Permit Application
Planning and Development Services
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:
RRa°POSED IN' R,�;Q1lEMiEN 'GaCAl111:
Address: D OXo tor-{- 1 �.Q-� n �1/Q, . -4o r-�- gif ree,
Legal Description: LAY vocod W uw,Ii Le 61 - (J5 LQ+— I)'1()a S)
(D12 I oq3 - la-14
Property Tax ID#: I?JOI - Lp C)(-o - 01 Lp 3 Lot No. f
Site Plan Name: Block No.LP )
Project Name:
Sei backs Front Back: Right Side: Left Side:
D'ETAILEtD DESCRI�PTIONO`F UI�IO"R°K•
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) fir. 51y-2 L12 -I— 100—ch,ro-F cl LH wcz ecQ ' re`floc� I +Ta Cz)ac,P
y n s-lam I 1 -��cvl �od]►ed r�mot�F'��� l�;�rn-c� r�o P S�S�-c,�. -t-� c:�c�2 _
60N�S U 10N I,N`FOR11/tATIO;N
Additional work to be pertormed under this permit-check w.all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof
To Sq. Ft of Construction: 2/ Sq. Ft. of First Floor:
Cost of Construction: $�l Utilities: _Sewer _Septic Building Height:
®INNER 0 RE
CONTRACTOR
_ _
IM
Name: r Am QSD1J
Address: '7�Dlo . or.{- I�1.1 'l-�a�.! Y�y�-� Company:S4- LAAAC aj�-6-f tr
Citjr: F�(� PI��Ce, State: 'L, Address: 1�13 5� �v�-�I� (Y1ccCQGtO (61yc{ .
IZip Code: 3-'1 q ;I Fax: City:12V+ S} Iu Ci C Stater
Phone No. Zip Code: 2 Fax:
E-Mail: Phone No ri'1 a- 39 11'3
Fill in fee simple Title Holder on next page (if different E-Mail Sf I AG t/'ODFinq 00. czl
I
from the Owner listed above) State or County License Me- 13'9n-1 1p
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
11�PLEiUiEN� �CloNSTitill�TIUN LI$ N LAU1/ �i0 'I�IATIQ: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/Agent Signature f C n r ctor/License Holder
STATE OF FLORIDA STATE OF FLOR DA
COUNTY OF COUNTY OF , 4 L&keLc
The forgoing instrument was acknowledged before me The forgoing instru ent as acknowledged before me
this day of. 20_ by this a!,eday of 20a by
(Name of person acknowledging) (Name of person acknowledging)
C � �
(Signature of Notary Public-State of Florida ) (Signature of Notary Public- ate of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification _
Produced Produced N00 PROULX
MY COMMISSION#FF 180517
No. Seal Commission No. 1/ ® 018
Commission ( ) XPIRES S��I�er 1 ,2
(407)398-0153 Floridalloiary$arvicg.COM
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.