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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
11%\03-'6 is j
' RECEIVED
- Building Permit �Applacation MAR 1 8 1021
Planning and Development Services Permitting Deaartment
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: LO* (> M WO —
Property Tax ID#: 330Y &D 3-00b7 -DDD--;IL Lot Nod�z_
Site Plan Name: Block No.
Project Name: Wdwasi 4;-,de -
Additional work to be performed under this permit- check all that apply:
Mechanical Gas Tank Gas Piping _Shutters' _ Window oors
Electric = Plumbing _ Sprinklers _ Generator - • Rob /o P.itch
Total Sq. Ft of Construction: MOD Sq. Ft. of First Floor: $1tD
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Cost of Construction: $ SO 000 Utilities: —Sewer +S c' ilding Height:
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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 HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
S A.
MORTGAGE COMPANY: _ Not Applicable
Name:
-,
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DESIGNER/ELLNGINEER: _ Not Applicable
Name: M.0_kae1 4r,dr�S'Or, 4]g aesigh &rar..Q
v Address: -2Igq 41wAi A 6&Z Ji 301 T
Address:
City:'rAdji,i karb&r SFeeh State: _
Zip:; q3) Phone N.L-gOa- W1 _
City: State:
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 is in conflict with anyapplicable 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) 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 IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOURNOTICE OF COMMENCEMENT."
4sigre VofOwiner/
Lessee/Contractor as Agent for Owner
Signat e f Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 5�- I�,I,�G+ 'L
STATE OF FLORIDA
COUNTY OF S
The forgoing instrument was acknowledged before me
this 1-7 day of tharc k 20a j by
The forgoing instru ent was acknowledged before me
this 4-1_ day of by
73-p►Ki7 rc 45K
Name of person making statement.
Personally Known OR -'Produced Identification
Type of Identification
Produced
Name of person making statement.
Personally Known /OR Produced Identification
Type of Identification
Produced
'State
.12
gnature of Notary Public- St;Gvjda)
Commission No. �.: a m.#GG95661
G9s66���
•. • Feb. 9,Ilia
(Signature of Notary Public- gfr�(�7R"d�? DW
'r ��i Corm,#GG
ommission qo r 6i :� : Feb, 9
e< !
REVIEWS FRONT ZONING SUPERVISOR..
COUNTER REVIEW REVIEW
'RLANS VEGETATION ._ SEA TURTLE,_ MANGROVE
REVIEW REVIEW REVIEW `REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19