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BUILDING PERMIT APP
All APPLI LE INF MUIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: v'Z p2 ` Permit Number: ti -mow Budding Permit Application Alarming and DeveiopmentServices 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: Clty_p S PROPOSED IMPROVEMENT LOCATION: ' Address: Property Tax ID It- a� 00 �r!i Site Plan Name: Lot No.-- L Project Name: Black No. Cl, 01 DETAILED DESCRIPTION OF WORK: New Electrical Meter Second Electrical Meter [CON:I�TRUC�TIONNFORMATIDN: Additional work to be performed under this permit- check all that apply: _Mechanical — Gas Tank _ Gas Piping Shutters 1�z/_ Windows/Doors — Pond _ Electric _ Plumbing _-Sprinklers _ Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Utilities: , 5ewer ` Septic Building Height: OWNER/LESSEE: City: I State: Zip Code: Fax: Phone No. E-Ma i I: Fill in fee simple Title Holder on next page (if different from the Owner listed above) CONTRACTOR: Name: City: _� MLILYA L state. F Zip Code: -•�Fax: Phone No-77 145 3 - t }� (-e E-Mail S�S1 M j}S State or County License If value of construction is 25M or more, a RECORDED Notice of commencement is requited. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. SUPPLEENTA C 3'NSTRUCTION LIEN :LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable Name: Address: City: State: Zip: Phone FEE SIMPLE TITLEHOLDER: — Nat 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 do the work and installation as indicated. I certify that no work or installation has commencer) prior to the issuance of a permit. St. Lucie Count�yy 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 Nome 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 f "e to Retort! a Notice of Commencement may re t in paying twice for improvements�'}Vpur ope y. A Notice of Commencement my t be r ord d in the public records of St. Lucie Co-Vnty end P4styd on the jobsite before the first inspectigr' . f your intend to obtain financing, consult with lecI off- an a ne before commencing work or recordi�ne v6 i/Kin}Fro Signature of 0v nerf' Lessee/Contraec�r-4s Agent for Owner STATE OF Fk/1OR1 COUNTYOO 77t-' rr,rvr,(7 =. Sworn to (or Iffirme f and subscribed before me of Ph sical1 resen a or Online Notarization th— day �f 202k by Name of person making statement. Personally Known __k` OR produced Ide I rc tion Type of Identification "Prod ced ( 'gna ure a Nota uu e ig a Notary Public State of Florida Commission No. Kari M Rice o '• '� Commissi��} F,�y Expires 0512a12p24 967938 REVIEWS FRONT ZONING _ COUNTER REVIEW DATE RECEIVED DATE_. OMPLETED Contractor/License Haider STAT9 0# FLORI sworn to (r affirmed) and subscribed before me of Ph s cal Presence or Online Notarization s day of 202q by Name of person making statement, Personally Known OR Produc d I�ntification �^ Type of Identification ;off Notary Public 3t Cotttmission No. ��e'��onda -" M RiCCabA1 My COMMB' - ISn G ~'�oF na� £xpireS i7517Rr�m G 967938 SUPERVISOR PLANS VEGETATION r SEA TURTLE REVIEW REVIW RE EVIEW REVIEW REVIEW E �� ;� CJ w v a m 0 0 co a G7 b z C m Otx�-4nawo .tom v: cn cn cn p Ul rnCD v00c)C1i,°i� o � .. cn Q oCO cn CA A K p N Q o z C6 €1l Cf} > r 0 m X M Co XCD > G3 m n Z N -i 8 � _� a x C o W ill -i 2 i4 m rn tQ N O a X D © NN -p > D b O r ? r- A c�li m m q 3] A X 0, rrnXty ca xm mr� �1 x_ a 0)m z n C] M X z z01 x 0 � � r _ N N no n N -�1 M_ m > © r Z m A x 0 m om� fJ7- O -< 50- m > x cv M O Z r 0 z Q 0 Z ^� oar m U) fit z m c r � m m z m C •C O-H prow 0 M e � C n -0 mm f� �m m m � v SU a� fl � O v m T 0 0 CD W j A W IN A � ^V 0 V r V O cn O V -0 V 3 [il O a. 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