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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11
Date: Permit Number:
RECEIVED
COUNTY FEB 2 3 1011
Building Permit Application Permitting Department
Planning and Development Services
St. Lucie count,
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 46271578 Commercial Residential
PERMITTYPE:
Address: J2 9t9_3
Property Tax ID #:
Site Plan Name:
Project Name:
r,L/ o?_ e_
7l7-DO0S- c`),
i
a_
.3 Lot No. .J
Block No.
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
I"E'lectric Allumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq..Ft. of First Floor:
Cost of Construction: $ ,DDO Utilities: _ Sewer _ Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
G. NI RAQ NOR:
Name e-t` Zw 6N.,77i
Name:
Address:2 VaJ C- Z
Company:
Address:
City: GG/�C State:�L
Zip Code: ,31f V P/ Fax: 772-11al—�Zf
Phone No. % 2—
City: State:
Zip Code: Fax:
Phone No
E-Mail: a*?0 A li •
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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 agreethat 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.".
Oar
Owner/ Lessee/Contractor Agent for Owner
Signature Contractor/License Holder
Si na re of as
of
STATE OF FLORIDA 1
STATE OF FLORIDA
COUNTY OF �l` . �.i)i�.l L
COUNTY OF
The forgoing instru as acknowledged before me
The forgoing instrument was acknowledged before me
thisday of 2049-k by
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica ' n
Type of Identification .
Produced
Produced
r
(Signature
(Signature of Notary Public- State of Florida )
,�SPayP''', KAREN S. NIELSEN
Commission UState of Florida-N($QQI)Public
"Ssion
Commission No. (Seal)
# GG 207484
My Commission Expires
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Rev. 217119