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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater S ?/1 Permit Number: \d5
- RECEIVED
MAY 0 4 1011
Building Permit Application
Pormlttlsg Dapartment
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE Jp_
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Address: 1 S /14oc-o LArJr✓
Property Tax ID#: Z JAI- GO - oouo '- Ob = O Lot No. �
Site Plan Name: 2�J • r'_1 c.e- Block No.
Project Name: /-•e-n L e f.e ►AC-e-AA LA,�
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Additional work to be performed under this permit—check all that apply:
Mechanical Gas Tank _Gas Piping _Shutter's —Windows/Doors
Electric _Plumbing _Sprinklers _Generator -Roof' Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ '[ Utilities: —Sewer —Septic Building Height:
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Name /UolLm A• -eL ti ,Name:
Address: ocZ M Ln,r� Company:`
_
City: I-o24 P i ucx- State:'Ea Address,,
Zip Code: 3Y9 LIS Fax: City., �:. _,' <:, State:
Phone No.��2 - JrZS(- 7 Lei-7 ZIP. 0 e;- _"_ , Fax:
E-Mail: 1 14Akac Phone No
Fill in fee simple Title Holder on next age(if different E-Mail
from the Owner listed above) 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.
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DESIGNER/ENGINEER: of 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
structur in e. conflict
c consult with yoiurHome Owners Association iandrreviewbylaws
your deed for any restrictions which may apply.obit such
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 JOB SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR A TTORNEY BEFORE RECORDiNG YOUR NOTICE OF COMMENCEMENT."
Signature Owner/ essee/ o ctor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 61C.VOfl SS COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this t�__day ofVNI%J ,2db-\ by this day of 20_ by
` C,A'`tea` '^ 5
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 Qq�l, QV Produced
of Notary P lic-State Si nature of Notary Public-State of Florida )
(Signature Y GIVENS ( g
DEANNA
�; N0(`��m bIAC StateOS6159da (Seal)
Commission No. ��b ��' jssionriHH Zp25 Commission No.
�` Expires Jan 28
'•: < �Q= My Comm National Notary Assn,
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REVIEWS FRONT ING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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