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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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:
PROPV-7
PROVEMENT LOCATION:
Address:d ,c^ 6�¢' i�/l6 pry c� 3 _
Property Tax ID #: J;� O j 4 ^/t" Lot No.
Site Plan Name: Block No. I I
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
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 _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $o?.9y/ Utilities: _Sewer Septic Building Height:
OWNER/LESSEE:`
CONTRA
Name - %/� - d/.rC*
Name: /C /�9.cZ
Address:A/20.5.
Company4L.(1
city:`Stat;7/-
Zip Coder Fax:
Phone No.
Address: C:: y-7
City: r�s7 9� .b'i!;-�f{ State:_G
Zip Code: �1� `�a Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MaiI�C �f�/rt� �SlaitN�FG, G�OyIiJ
State or County Licensee j5'd5�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,S00 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFbRMAfION
r5; y
DESIGNER/ENGINEER:
_NotA Applicable
pp MORTGAGE COMPANY Not Applicable
Name:
Name:
Address:
City: Address:
State: City: State::
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDINfCOMfPANY: NotfApplicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip:
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.
which is inOconT1icmtaawith any ano pplicableiHome OwnerstAssociationlrules bwill ylaws or and covenants that may estrict or
structure. Please
prohibit such
consult with your Home Owners Association and review your deed for any restrictions which may apply.
Inconsideration of the granting of this requested permit, 1 do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes St Lucie i
and 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 an attor before
commencen work or recording o Commencement. .
Signature of wner essee/Contractor as Agent for Owner Signature of E n ractor/Ucense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY (
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_dayof 2020 by this. day of_ .2020 by
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
roll
—� eher_`�� _._.�------
(Signature of Notary Public- oo a (Signature of Notary Public- State of 11,n,rida
NOT YPUBLIC Y Aannah DeRuyascher
Commission No. � ��%Ta4 OF FLORIDA Commission No. _ NO YPUBUC
�; a Comm# GG241993 OPFLORIDA
ip
E 19�� Tres 7/25/2022 ": Comm# GG241993
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW
REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
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