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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDCZ 10
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Date: ,i 2d21 Permit Number: �J y��L7
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- - Building Permit Application MAY o 7 2021
Planning and Development Services
Building and Code Regulation Division P.-rmittkA bepartment
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential -7
PERMIT TYPE:
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Address: /2
Property Tax ID#: J ya:Z 10 — 0,3 3 -D LL 6 Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters -Windows/Doors
Electric Plumbing —Sprinklers _Generator _Roof Pitch
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Iatal Sq. Ft of Construc�i�k(ox' Z �� Sq. Ft. of First Floor:
Cost of Construction: $ 74)d Utilities: —Sewer _Septic Building Height:
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Name Name:
Address: a VAA_ _ -.Company.:
State: Addre'ss:~
Zip Code: Fax: City: State:
Phone No. !_';
3l7• �;Zip:Code,:, - _ _ Fax:
E-Mail: Phone No
Fill in fee simple Title Holder'on nex page (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: ,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 JOB SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOitzDMAIG" YOUR NOVICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day}-of p,20QJ by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Knouz OR Produced Identification ✓/ Personally Known OR Produced Identification
Type of Identi -cati _ Type of Identification
Produced Produced
(Signature of Not Public-State of Flod (Signature of Notary Public-State of Florida }
Commission No. �2os0`Y`P,,
U�WYB.HUMPHR.EY
*: O v �SION#GG:40817 Commission No. (Seal)
�r XPIRES:March F.,2023REVIEWS FRONT G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTERW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.