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All APPLICABLE INFO MUST BE COM ETED FOR APPLICATION TO BE ACCEPTED
Date: I �G� ® Permit Number:
11�� 03
`11'0 s►' IJ1� �* J�;°� SEP 14 2021
O (. 5ti At, .Eadln -aunty
Building Permit Application
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 CBDG Funding
PERMIT APPLICATION FOR: 6
FR;(JPQSED IMP,RQI7EMENT LOCATCQN
Address: SE 019 S 09A*N R -* :5V2 :ApmbA u Beech `I
NJ
Property Tax ID#: 4 50 a. Gcw w035, wo .1-.. Lot No.
Site Plan Name: Block No.
Project Name: C"diU 50'2 6 !f
DETAILED DESCRIPTIQN:OF W RK
MCFA • A r� Jai ry✓cry
New Electrical Meter Second Electrical Meter (Affidavit required)
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CQNSTRUCTIQN.,INFOR(VIATIO.N::ten,.
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: 'j Q Sq. Ft. of First.Floor:
Cost of Construction: $ ,y / a Utilities: _Sewer _Septic Building Height:
QWNERJ.ESSE�F.` � � CO'NTRACTOR - ��'� � '
s s
Name Jose— 914 1 'UQA A Name: l YID S e60Yrn
Address: el6 ®O �• mL�t3i�J �Rl$l Company: JU C--pi �C(X YI
City-E)c 059,v B—CACE State: ft L Address: '910
Zip Code: 3�51 Fax: City: h4ia t, State: FL_
Phone No. 5 l.2 gab 0 Qt4l; E- Zip Code:23t�' ; Fax:
Mail: /J20C9 Z yes T A06 - Y% Phone No _7 %, 4-43 9S 9 D
Fill in fee simple Title Holder on next page(if different E-Mail Y CtA l7Cp, bt?.(.�.[1�a g t y ,cfu
from the Owner listed above) State or County License_ 87
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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�UPP N `AL CO�TRV CTti 'A'
?o",T:.i�s,.,.'+`H,c£ .a-:r_ `
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: I
City: State: City: ! State:
Zip: Phone Zip: 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.
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 conflicts with any applicable Homeowners Association rules,bylaws or and covenants that may,restrict or prohibit such
structure.Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
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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 inspection. If you intend to obtain financing, consult
With lender or an attorney before commencing work or record in our.Notice of Commencement.
Signa f Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF F-L-
i
Sworn (or affirmed)an subsc 'bed before me of ii_ hysical Presence or Online Notarization
this L day of S 202f by
• M��-i.a„�I.-o Sit-»fc'��Sz-�
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
I
(S 06tary Public-State of Florida) i
Commission No. G6 1`L3 (Seal) ..•, ,,,oa,�,p„MAofftnde
Jorge Rowseou
R My mnusfgn Go 193011
�J BWret 05/04'2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5
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