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All APPLICABLE INFO MUST BE CO[,Y;.-_�JED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
RECEIVED
I
MAY' 21:1011
Building Permit Applicats®rpermittinyDepartm'ent
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL34982 Residential x
Phone: (772) 462-1S53 Fax: (772) 462-1S78 COfTI[►Y1�CIal
PERMIT TYPE:
Address:
Pro pertyTax ID #:
Site Plan Name: _
I]- i-i- NI -a -
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator'.
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �� rl %qs % 5 Utilities: _Sewer _Septic
Name PH4- ' -i- r Lu —'''. r
Address: S
City:® rf I
I` -
Zip Code: p�Fax:
e� - e
Phone No. d;
E-Mail: I-O d a00 3
Fill in fee simple Title Holder on next
from the Owner listed above)
e:i r-j�—
N IA
( if different
V
W,
Lot No.
Block NoI.
I
I
-Windows/Doors
Roof ; Pitch
Building Height: i
Name:
Company:
Address:
City:
Zip Code: Fax:
Phone No
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.
State:
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is'hereby made to obtain a permit to ao the worK ano IMAd I n d IJVI1 d] 111U,I GO u.
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
swhich is in tructure. Please conlict sth any ult with applicable
HomeOwnersOwners Associationme taond review bylaws
your deed or any restrictions wh which may arestrict or pply.
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 RECORDiED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
ORE RECORDING YOUR NOTICE OF COMMENCEMENT."
WITH YOUR
LEN ER OR AN ATTORNEY OEF
Signature & O ner/ ss e/C tractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF CA—
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of A/A`IL.— 2071 by
l
this _ day of 20_ by
ailc,<�Z��
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
"" ELLEN VAUGHN
tPRV P(jB
di° `�: Stats a
(Signature of Notary 9 i? C9q%rALt3)on # GG 270079
`
(Signature of Notary Public- State of Florida )
i� /F OF I'll
My Commission Expires
Or, ob r 22,
Commission No. 2022
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS I
VEGETATION
SEA TURTLE
MANGROVE
REVIEW
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19