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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED nn
Date: Permit Number:
RECEIVED 4-
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IF`LW�*f
JUL 21 2021
Building Permit Application 6t.Puci fitting y
Prmtting
Planning and Development Services
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION;
Address: I2-1&q Kk HARWY T
Property Tax IC
Site Plan Name
Project Name:
'; ,
DETAILED DESCRIPTION OF WORK:
4`� VA"n114 �y� `PP�(1�a� �.IOi- o0`IO
New Electrical Meter Second Electrical Meter
CONSTRUCTION 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 Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ ,3()I ()oo
Sq. Ft. df First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 'A HOP 1.490 I S
Address: -ri
City: A State:
Name: i 64ez%&_9
Company:
Address: 6,01
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Zip Code: 3A 0 Fax:
City: __4::�ff164127
State:149"
Phone No.
Zip Code: 3dtt11A Fax:
Phone No -] % -
93,' 01 G%
o
E-Mail: L o®f+f 1 ' [,pm
Fill in fee simple Title Holder on next page ( if different
E-Mail >00 6- ® ,ze— D,
e 69P1
State or County License GEC,oA
Cv09
from the Owner listed above)
I &a 222
It 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
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 Count 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 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 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 inspectio If you intend to obtain financing, consult
with IjRnder or an attorney before commencing work or recordinAvour Notkt--of\Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signa ure of C tr ctor/License Hold t
STATE OF FLORIDA
STATE OFF RIDA
COUNTY OF_Zd jat /)
COUNTY OF
f
Swor to (or affirmed) and subscribed before me of
SW to (or affirmed) and subscribed before me of
l/
Physical Presence or Online Notarization
Physical Pres nce or Online Notarization
this /!o day of /YIAr 2020 by
this day of Jam 2021 by
9t #_ r . AeQcRo
304 N� V41Jq
Name of person making statement.
y;
Name of person making stat ment.
Personally Known OR Produced Identification v
Personally Known OR Produced Identification
Type of Identificatijgn
� Produced L %aj0 D.S'�%��(O
Type of Identification
Produced
1 Y
f r'
(Signature of N tary PuR*"bf
(Signatur
Notary�Public State of Flonda
Commission No. MarypID@h
t'ZOZ/t:Z/60 sendx3 OP 4b.
Commissi n No;�ssyc HH uoisslwwo �tyy9
My Commission HH 045562
Expires 09/23/2024
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eP�iol4 /o eieiS ollQnd iUeioN NIP. 70
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
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MANGROVE
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ev. 516120