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All APPLICABLE INFO MUST BE COMPLgED%R APPLICATION70 BE ACCEPTED
Date: Permit Number:
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Q . =♦Q:Or Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982 .
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: e,ro o
-!PROPOSED IMPROVEMENT LOCATION:
Address: 1-10$ York C.tI fart P;e.rCZ_JL. 3�as Z
Property Tax ID#: -4 4Z 1 " 6 O oo -") Lot No. �-
Site Plan Name: -1-1 0 8 Xotrk 0 Block No.
Project Name: 1-1 O S �*AL C�- (L-•etch�r
DETAILED DESCRIPTION OF WORK:,.
k e ro o f Te a.r of-re e-X i 6E'Y-rt ro o4i v`q in a4-e-r vr at(i
e4-c , n o•; -�'o fr C Zo 10, r„1 i>n uh(Q/(�I^�►e�1 .9"( t �l- tg Tr1o&*
_S a�d 1�s�-hll 1K o Ur
CQrnS�.d
New Electrical Meter Second Electrical Meter
.CONSTRUCTI-ON INFORMATION
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors., _Pond
Electric 'Plumbing _Sprinklers _Generator ✓ Roof Z S/(Z Pitch'
Total Sq. Ft of Construction: V O O Sq. Ft. of First Floor:
Cost of Construction:$J I T 0 Utilities: —Sewer —Septic Building Height:
6WNER/LESSEE: CONTRACTOR::
- -Name-_— o-sk-Q-a (L MOLL-; Name: Fk r�-Q ro R Qy ACi0 i
Address: 110$ IdX 0' Company: De;ng do ^9 , Co.
City: State: Address: Po. fox S8( ��ll
Zip Code: '34"et $ Z- Fax: City: i9cef, S�: L mac' e- State:�L
Phone No.C-1,z� 33z `3-7 S Zip Code: 8 Fax:
E-Mail: PhoneNo('l"12) 3 -e"L "31 (,-7
Fill in fee simple Title Holder on next page(if different E-Mail 801 A q roo ;-i✓ 9 co®A Ma;(.cow"
from the Owner listed above) State or County License CCC l 3 3 2,f 11
-
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: =
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'Assoclation 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 con currency 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie.County,and posted on the jobsite before the first inspection., If you intend to obtain financing, consult
with lender or an attor6e •before commencing work or recording our Notice of Commencement.
Signature of Owner7 Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF COUNTY OF—
�^ t , ` d OUNTY OFSTATE OF ORIDA S� �C
Sworn to(or affirmed)and subscribed beforeme of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
2v2V by thi �`--day of 201 by
Name o e son making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificatio
Produced L� Produced
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REVIEWS FRONT ZONING , SUPERVISOR PLANS VEGETATION C' 22'r�,Q� ROVE
,COUNTER REVIEW. REVIEW REVIEW REVIEW REV R IEW
DATE
RECEIVED'
DATE
COMPLETED
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