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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Numberr
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Building Permit Application St. Lucie County
Planning and Development Services Permitting
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: �"�n4V 4 '%
Address: I L15 7TC__0KiK6
2 2
Property Tax ID #: 313 ++ Lot No.
Site Plan Name: J (-� e vy)flde 1 Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required) 112r V IGw5 15bbiry
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Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters X—Windows/Doors _ Pond
,Electric Plumbing(( _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: -1Sq. Ft. of First Floor: I .Licvo
Cost of Construction: $ Utilities: —Sewer Septic Building Height:
Names 1XQe Name:
Address: �� o'1 I Company:
F City: b A 1� e In( -State: �L— Address:
311
Zip Code: --q_1 Fax: City: State:
Phone No. I%R- 37D - 505-1 E- Zip Code: Fax:
Mail: C� its cy- c` mccj5j, Yle-�_ 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.
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DESIGNER/ENGINEER: �L_ Not Applicable
Name:
Address:
City:
Zip: Phon
FEE SIMPLE TITLE HOLDER:
Name:
Address:
f-ity-
Zip: Phone: _
State
MORTGAGE COMPANY: Not Applicable
Name:
Arirlragc-
City: State:
Zip: Phone:
Not Applicable BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 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.
Luci ounty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with I nder or an ,Lttornev before commencing work or recording your Notice of Commencement. i
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 6*. \, lJc:%c
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this °j1_ day of Jar 2Ca`�Y
Name of person making statement.
Personally Known OR Produced Identification
Tvoe of Identification Produced�L
(Signature of N
Commission No.
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
7 DEANNA GIVENS
(�;@ public . State of Florida
mission # HH 086359
` My Comm. Expires Jan 28, 2025
,5onded through National Notary Assn.
ZONING ANGRO
REVIEW I S REVIEW R I REV EW PNS I VREVIEWON I SE REVIEW LE MREV EWVE