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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: — Permit Number,mil , - O Y0
L,LLY, RECEIVED
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*D1 Building Permit Application OCT 18 2020
Planning and Development Services 1st•Pe ucie rrnitir��
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Building and Code Regulation Division Commercial 3 5Av Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: ro o
PROPOSED`IM,PROVEMENT LOCATION:
Address: a u
Property Tax I D#: 3 i b 3• �_d�.- ®� 0^ C�d d Lot No.
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Site Plan Name: Block No.
Project Name: I�
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DETAILED DESCRIPTION OF,WORK: ,
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New Electrical Meter Second Electrical Meter (Affidavit requiired) a p Sk
CONSTRUCTION INFORMATION: "
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Additional work to be performed under this permit-check all that apply: i
_Mechanical _Gas Tank _Gas Piping _Shutters _Windo�s/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator VRoof ?iz,, ch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic B1 ilding Height: !d
"OWNER/LESSEE:._ .. CONTRACTOR: I
Name cL Name: P7J5R.
Address: N Company: U, (✓.
City: FT State: R- Address:
Zip Code: _Fax: City: State:, l-
Phone No. `?7,� f�1• ��a E- Zip Code:_� 7 Fax:
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Mail: Phone No-7 ( ' M
Fill In fee simple Title Holder on next page(if different E-Mail ws
from the Owner listed above) State or County Lice se ril —
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If value of pp struction is Z500 or more,a RECORDED Notice of Commencement is required.
If value of His$7,500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: i' _Not Applicable
Name: Name:
Address: Address:
City: State: City: d State:
Zip: Pho Zip: Jh n 9
FEE SIMPLE TITLE HOL Not Applicable BONDING COMP iNot Applicable
Name: Name:
Address: Address:
City: City: it
Zip: Phone: Zip: Phone:
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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 t 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 lio obtain financing,consult
with lender or an attowey before commencing work or recording our Notice of Commencement.
Signature of Owner/ se C n as Age t for caner
STATE OF FLORIDA u C
COUNTY OF Y1'�J4T 41�W
Sworn 1�to or affirm d nd subscribed before me of ,--"Physical sical Presence or Onlin I Notarization
this—�-3�,day of 2qp-_1 by
Name of person making statement.
Personally Known OR Prs uced Id e tification
Type of Identification Produced r ' 1
(Signature of Notary b ic-State of Flori a)
OCT 1 2020 ;,I ;,St2U441 A1 MM1SS10N
Commission No. ,. '. ; 1AYCo
;=o4P,.X�!B4•;, AUD EY B.HUMPHREY .i {{ -� ;�; g•N,-r:`� .`E•,
MY COMMISSION#GG 300817 St.Lucie County yam;'-;' ,: EXPIRE ' a
EXPIRES:March 6,2023 Permitting :; "�.y,>(`- `` i3endeJThcuNoh" ct
12 Bonded Thru Notary Public Underwriters
cerm�aess.....
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE 1
RECEIVED
DATE
COMPLETED
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