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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECOVED7
9U. LUC
AUG 30 2021
St. Lucie County
Building Permit Application Permittil
Planning and Development Services
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: L!Ce+V1 CD L_
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Property Tax ID #:
Site Plan Name:
Project Name:
0 - 0 Lot No._
Block No.
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New Electrical Meter Second Electrical Meter
r
(Affidavit required)
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: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: — Sewer Septic" Building Height:
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ES_§5E'RW XRP2� ARM 09 HIM.
Name
Address: :R2P_1 S'; aYYI
C _�'_JZV V\eV6 " City: �e_: State:
Zip Code: Fax:
Phone No.'717
City. ?.10 P_ State:
Zip Code: 314-CS 'Q_i Fax: 77;g - 35g, U3C
Phone No 1 -12 - AGO
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail lzt, n't 2 �b2 11
State or County License E C -7 S_
if 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.
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MORTGAGE COMPANY: _
Name:
Not Applicable
DESIGNER/ENGINEER: Not Applicable,
Name:
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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 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 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.
Luand posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wit r r an ate before commencing work or recording your Notice of Commencement.
Sifaturepf Owner_ " Iessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmeA and subscribed befgre me of Physical Presence or Online Notarization
this�Q day of 2D= / by
Name of person making statement.
Personally Known Pr ced Ides]-tif-icatiQ/n
Type of Ikntification Produced J7�i� '�fi1 C
(Signature of Notary
Commission No.
ic- State of Florida )
(Seal)
REVIEWS _ FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ryo�,;....... AUDREY B. HUMPHREY
MY COMMISSION # GG 300817
`a EXPIRES: March 6.2023
Bonded 11rrNotary Public Underwrters
—_`
SUPERVISOR I PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW I REVIEW REVIEW REVIEW REVIEW