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All APPUC"iE INFO.MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
�3�a
Permit Number:
s5irc LUC 111
Planning and Deve
P.
lop ent Services
Building and Code Regulation Division
2300 V1rginia Avenue, Fort Pierce FL 34982
Phone: (772)
Building Permit App1ication
462-1553 Fax: (772) 462-1578
Commercial
Residential
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PERNA IT APPLICATION FOR
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Additional work t
Mechanical
Electric
o be performed
Gas
unde
Tank
Plumbing
r this permit -
check all that apply:
_vas
Plpirg
_ nutters
Wmaows/uoors
_Bona
Sprinklers
Generator
Roof
Pitch
dMEREVI
Total Sq. Ft of Constructioni, WERE Sq. Fte of First ""'lor
0 N' i ut-816to IFCost of ConstructionSt � � �9
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Name
Name.
,e r
Addrosse%/E
cow$
1
rfrfj
_. State:
Zip Codes.
Phone iNo. P71 (1;� 8aR- 5a�y
E M a'1' I:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
Company
e 1010
Address
City:
T.* EP6�C,5
Zip Code
Phone N
E-Mail
State or
ay9�a�
al LD
I CV71cs
County License
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
if value of HAVC Is $7,,500 or more, a RECORDED Notice of Commencement is required.
Meru JLA icy U
►� way
+ ax
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ai � _
State: �-
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F�
f
MMI
am e:
Address.
citya State•
'-iP� Phone
FEE SIM
PLE TITLE HOLDER
� Name:_
Address
•
amity:
Zip: P hone•
OWNER/ CONTRACTOR AFFIDVIT'41D Application is hereby made to obtain a pe
i certify that no work or installation has commenced prior to the issuance of a perm
,.S
'Pon
whichtucie
In
nfl
'ih any aps no piica�e Home Owgranting
es s�*11 authorl
a
the
ermit
holder
a� bufld
or roh
structure. Please cor►sult �nnth your Home Owners Association and review your deed for any restrictions which may appl.
1n consideration of the ganting of this requested permit, I do hereby agree that I will, in all respects, performt
in accordance with the approved plansthe Florida Building Codes and St. Lucie County Amendments.
:The following building permit applications are exP�,�,�r f�
,
Not Applicable
�-Um1'HNY:Not Applicable
Name:
Address:
City:State:
Zip* Phone:
BONDING COMPANY:Applicable
Name:
Address:
City:
Zip:
Phone:
rmit to do the work an
d installation as indicated.
it.
-��•r•��oundergoing a full concurrence review
accessorystructures, swimming pools, fences, walls, SignS, Screen
'ARNING TO OWNER: Your fa@1ure to Reco�a.,N,..__o imp
,, room add
blest str
he work
It10115,
lbit
ucture
such
rooms and accessory uses to another non-residential use
�M a ��,,,e fCommencement may result in Paying twice fo r
rovements to your property. A Notice ofiCommencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend t��o obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of CommenrPmpnr
Sli'gnat U r
e of 0 wn Le
STATE OF FLORIDA
CO U NTY Of
e/Contracto'r as Aftnt for
It
Si , LU Cl E.
Sword (or affirmed) ar�d subscribed before me of
YPh sicalPresencreor Online Notarization
this � day of �U 1�e. , 20 24 by
_r Name of person making statement.
Owner
Personally Known OR Produced Identification
Type of Identification
Produced
_.—
Signature o
ntractor/licen3'e Holder
W
STATE OF FLORIDA
COUNTY OF J
IS
o (or armed) and subscribed before me of
sisal Presenc or Online Notarization
this day of ►7�— 202-1. by
tjp
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
3
0-
Signature f Notary Public- State of Florida )
(Signature of Notary Public- State of Florida )
Commission No., 6 E°��� t ,C � " c�""r
..YriW$a)Ntr� _....._.�_C
....._
REVIEWS
COUNTER
DATE
RECEIVED
DATE
COMPLETED
R'5/
ev.
sion
No.
lr
)
$�uyruvuc�7cw�eO ,�stllf! 5��'3l`�
MvqF Montepa e ,��"� Notary Public sta e Forida
My Commin" GG 21 990 ? � Margaret E Mo t are
'' 'peres Uq0P/U5;4Udz Z MY Commission G 74990
110 ilhi' I �EX0,ires 06/05/20 2
REVIEW
REVIEW
� PLANS
REVIEW
TION
REVIEW
iSEA TU
REVIEW
REVIEW