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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r-- '� (' --) -\ Permit Number:
Building Permit Appii
Planning and Development Services .0
Building and code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:
Address: 13(o
Property Tax ID #:
Site Plan Name:
Protect Name:
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MAY 14 2021 . 6
tl-'County, Permitting
Residential '1/
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Lot No.
Block No.
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank J Gas Piping —Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
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Total Sq. Ft of Construction: 2 Sq. Ft. of First Floor:
Cost of Construction: 7 q00 i-o Utilities: —Sewer _Septic Building Height:
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Name �- t. cAL.4P -tf— Name i/�'L (i 1, _'L 7 V
Address: Z ^(�� w(— Company.:�C1a/aze 9C zwc
City:Pc►(l7E S-� ECG Stated-( Address: 4.
Zip Code:'` �'� Fax: City: °SC f�`?�C'y�/ Stater
Phone:N �? Z �Z� — L `L� `'l ~Zip Code: ` ' �/9 7;- Fax:
E-Mail:. Phone No p 77 Z IT
Fill in fee simple Title Holder on next page ( if different , E-Mail b U cc 6 L.- LJ
from the Owner listed above) State or County. License �, 17
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.
ER/ENGINEER:
Name:_
Address:
City: ra
Zip:
Pho
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable MORTGAGE COMPANY: _'Not Applicable
Name:
State
_ Not Applicable
Address:
City: State. -
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_Not Applicable
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 andreview your deed for any•restdctions which may apply.
In consideration of the granting of this requested permit, I do hereby agrde •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 FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH IYOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y9B?3 NOTICE O��[>5�MMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder'
STATE OF FLORIDA / _ STATE OF FLORIDA
5* l uS
COUNTY OF ,,r COUNTY OF (-()cy_-t rJ
The forgoing instrument was acknowledged before me
thisday of <'C�_, 201A by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
ii ture N ary P
J ission No.
REVIEWS 'FRONT
COUNTER
DATE
RECEIVED -
DATE
COMPLETED
The forgoing instrument was acknowledged before me
this __U day of Nord 20_A by
-
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced PJ q3.D - otoo 'Sg - 0S+0
%-;..1 ��RM(OAKCI (81atO-L
p (Signature of Notary Public- State of Florida )
Fn�HH044428 Commission No. �0 (Seal)
I' E1tpi1N 09J2Q=4
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ZONING SUPERVISOR PLANS VEGETATION SEA TURTLEM
REVIE,W REVIEW REVIEW REVIEW REVIEW I
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