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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I 00 15`
Date: Permit Number:
JUL 0 5 2611-t`
Building Permit Application PFt1"J"II iN
Planning and Development Services S`• Lu Go�•�t`', L
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Gas piping l
PRO.POSfD IMPROVEMENT LOCATION: , g �` 5 � # .
�. r .. .,. uE.
Address: 10201 Crosby Place Port Saint Lucie FL 34986
Legal Description: POD 26 at the reserve replat cypress point lot 116
Property Tax ID#: 332771000180002 Lot No.116
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
"r e�ill r* ar �nep 4'
DETAILED DESCRIPT'Ibi� a
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CQNSTRUCTIO,N IN�FOR"MATI®N �
Additional work to be ertormed under this permit—criecK all apply:
�HVAC Gas Tank as Piping Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers R1 Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �aS v_7 Utilities:lnSewer 0Septic Building Height:
O\IUNER/LESSEE £ CONTRA FOR: ffi ��,���
NameThomas Needham Name: � ` U'l
Addres •10201 Crosby �Q Company: 1
1
City: L�i�-� 1,1A State:_ Addre
Zip Code: K YtD Fax: City: State:
Phone No. Zip Code: ax: �—
E-Mail: Phone N
Fill in fee simple Title Holder on next page(if different E-Mail:. ; 4
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
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 any applicable 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 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
Signature of ner/Lessee/Contractor as Agent for Owner Signature of Contra for/License ITolder
STATE OF FLORID I STATE OF FLORID
COUNTY OF I L1-� COUNTY OF !!� —
The rday
ing instru nt was acknowledge efore me The f oing instrument was acknowledged before me
this of 20k-by this,'! day of f 20 [by
(Name of rson acknowledging) (Name of peknowledging)
cc� .1 rso ac
'11 AA C� a, e V' a'
(Signature oT Notary P blic-State o orida ) (Signature of Notary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific ion Produced Type of Identificati n Produced
Commission No. e I Commission No.
Notary Public State of Florida
aF� Antonia M Paula �,~> " Notary Public State of Florida
rr
91201
I Expires 0212712019 My Commission FF 191201
Revised07/15/201 °�^ Of Expires 0212712o19 i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS