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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 7r'nn
Date:
Permit Number:
+ Building -Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1558 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: _6M % WAY
PropertyTaxlD#:
Site Plan Name:
Project Name:
No._
,k No.
r1VQ
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors ..
1.
Electric _ Plumbing _ Sprinklers _ Generator _ Roof' Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �Utilities: _Sewer _Septic Building Height:
Name 6eL &V T, ' L•e t Z. OLDS' ,,ll
Address: / olL � � Ps617�A� J 63A
City: K, v' qC7e--i �L✓ state:
Zip Code: 31,!Ci Fax: �
Phone No. '7) 2 -� 161 ` d }
E-Mail:_11 kyT,. _%0
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: A6I Ta Lt t1 l 1� IVA . �e
Company: -
Address:
City: State:
Zip Code: c Fax: N
Phone No 7 -L �� ` �J b E-Mail ,L L'•h? /t-f-1 ^v)as
State or County License- 481 7
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.
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby maae to obtain a pe iML W _ ••� - - - - -
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
structure. Please c consult with pyoiur Hlome Owners Association andreviewyour deed oaws or and covenants
any restr ctiions which may apply obit such
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING vni IR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee Contractor as Agent for Owner i ure of Con actor Licens der
STATE OF FLORA STATE OF FLORID
COUNTY OF � l COUNTY OF
The forgoing ins t ent was acknowledged before me The f oing ins ? ment was acknowle20g�dt before me
thi� day of 20W by this day of ±!
Name of person making stateme Name of person making statement.
Personally Known OR Produced IdentificationPersonally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
`,S atgre of Notary Public=3t,4e ot.Florio8 )
Commission No. (Seal)
REVIEWS LOUNTER O I REEVEW
DATE
RECEIVED
DATE
COMPLETED
(Signature of Notary A�blic- State of Florida )
Commission No. (Seal)
SUPERVISREVIEWOR I REV EW NS I VEGETATIREVIEWON I SIATURTREV EWLE MANGROVE
REVIEW_