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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
0
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: F)?,n e IC- L u ,N ,J tO Wd'f' c
Address: 10 1R_' 0 p pi- r P1 EtZ CC t:�'/ A -
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Property Tax ID #: Lot No. /_vT 7_0 .
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit -check all that apply:
M chanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
00
Cost of Construction: $ �f%U� Utilities: —Sewer —Septic Building Height:
Ip li N�� L. � ��
Name:
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Company:
F • r� f✓ C i State: F4
Address:
City: State:
Zip Code: 3 `%c! � Z Fax:
Phone No. 77 Z - Zc3/ E-
Zip Code: Fax:
Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail _
from 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 HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: - Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
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 instal lation°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.
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 co mencing work or recording our Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID 1
COUNTY OF • `A1
Swor to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of —` 202L by
Name of person making statement. ��'
Personal wn � OR Produced Identificationy
Type of. denti ication od ced
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JSignatuota blic- tate of Flori ) ::!:.LAStIAyNAING
RAM-RMMING�.: MYCOMMISSION#GG279A. (Seal) EVIREDecember20,2027
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REVIEWS GETATIEATURTANGRO
I CFRONT OUNTER I ZONINGREVIEW I S REVIEW UPERVISOR I REVIEW I PLANSV REVIEW ON S REV EWLE I MREV EWVE
RECEIVED
DATE 7±
COMPLETED