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All APPLICABLE INFO MUST VMWLE�TEEeD'fOR APPLICATION TO BE ACCEPTED
Date: 01 1 MWt1'* Co WW Permit Number:V
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Building Permit Application JUt
Planning and Development Services Pertnitting DepartmentSt.Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
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Address: 1 t lrJ Q _ �o�-C ,1 4LC*, .. -3
Property Tax ID#: .519 '_lp 1-p 3 4 �_o 6 t Lot No.]
Site Plan Name: L A )Ll~t'Dc'd)10 4X Lt I` U�J `i Block No. ]
Project Name::
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters. Windows/Doors
_Electric _Plumbing Sprinklers _Generator l Roof Pitch
Total Sq. Ft of Construction: 97 Sq. Ft. of First Floor:
Cost of Construction: $ S�G_IG Utilities: —Sewer —Septic Building Height:
goz`xkY-� 's9 y-a a .e=.�' a 5_1,d.�$ .�,W U€�
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Name v Name: i
Address: k SZO 1 1 pp,A Sa "Lie (;�Llqlo Company: - 5
City: State: Address:
Zip Code:3'-I N ,57 Fax: City: State:
Phone No. 00 Zip Code: Fax:
E-Mail: C-Of-O `c -vz-+,jk'pkk- Phone No
Fill in fee simple Title Hol er on next page( if different E-Mail
from the Owner listed above) 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.
DESIGNER ENGINEER: ' " Not Applicable MORTGAG COMPANY: .,; —Not Applicable
Name: L fl Name:
Address &o (,oL- +(', t Wi �L bale= Address
City: State---, City: .�j0 11 �� _ State:M
Zip: Phone gC2 -"7 �o-� Zip: <4p Shy p-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.
1 certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that[.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 ARID
POSTED ON THE JOB SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOU01ENDER OR AN ATTORNEY BEFORE 12ECOIRDo NI;;YOUR NOTICE OF COMMENCEMENT."
Signatu ee%Contractor as Agen Signature of Contractor/License Holder a
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The fo oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this t day of 20A by this day of 20` by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification (� J / Type of.ldentifi,cstion
Produced_F( II �V Produced
(Signature of Nolmify Public of Florida) (Signature of Notary Public-State of Florida )
Commission N (Seal) Commission No. (Seal)
`�1pRY pVBi� ELLEN_ VAUGHN
y u is
Co mission # GG 7 ISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEWS F ` T My CRQ> 7on E plv�s
Tf_RWPr 20 2 REV W REVIEVI/ ' -REVIEW REVIEW. REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.