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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S a Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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PropertyTax ID #: WU �09,.. - 000 Lot No.
Site Plan Name: 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 — Roof Pitch
Total Sq. Ft of Construction: 6L\<0 rj� Sq. Ft. of First Floor:
Cost of C nstr-uction _� k3q, 00 Utilities: —Sewer —Septic Building Height:
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me NgNy.[ ao .Name:
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.ddress: L�UI �tn>✓ _ P -Y:'
City: i Qr+ P1e L& �) orl 01o. State: Address:
3� q State:
,IZip Code: Fax: City:
Phone N .17Z - Zip Code:` , Fax:
Mail:( M993 1.{a�l�aa,r�awi Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
om 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.
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DESIGNER/ENGINEER. —
_, .
Not Applicable
MORTGAGE COMPANY. _
Not Applicable
Name:'
Name:
Address:
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: —
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
4 a +k ,.,nri. nnH
inctallntinn as indicated.
OWNER/ CONTRACTOR AFFIDVI 1: Application is hereby made w ddialii a N=1111L< <� - - - -
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
swhich is in tructure. Please consth ult any
with applicable
oiurHlome Owners Association anAssociatiodrreviewylaws or and your deed or any restrictions nts that may
hich may arestrict orl. prohibit 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 .DOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
-�••�� o i
N OTICE OF COFMIMENCEMENT "
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOffIVIRAU
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Signature of Contractor/License Holder
ignature of Owner/ a see ntra as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sir_ �..�z��
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowleZdoged before me
this�� day of `Iva ZCa'1 by
this day of
\\
a'rnC_ V •c d e
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known' < OR Produced Identification
Type of Identification
Type of Identification
Produced T;L ID L
Produced
dnature of Notary Public State of Florida )
(Signature of Notary P lic- State of Flor'd DEpNNA�ate 0i r106
P'u'e" , ( mssi o
Commission No. 4�-:
S`C mission No. (Seal)
C eSHaaby652
?� MY �ommn Na �o�al lotatY
PLANS
VEGETATION
SEA TURTLE
REVIEW
MANGROVE
REVIEW
REVIEWS
FRONT
SUPERVISOR
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.