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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �Q _ (I
Date: 1 I Z Z�i `\ Permit Number: 1Q(
`O
LUCE RECEIVED
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Building Permit Application
Planning and Development Services4. L-ucle Coun
ftrmi ing
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED
Address: CA -AL'- -br. EDrk-- f�Q,(C'q_ 1121, 3410
Property Tax I D #: .1 3 ( ,,ll D • Lot No.
Site Plan Name: _S�j�� o1rr 1 7i bI v�. Block No.
Project Name:
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Windows/Doors _ Pond
Roof Pitch
Total Sq. Ft of Construction: 6U Sq. Ft. of First Floor:
Cost of Construction: $ y 10V Utilities: Pewer _ Septic Building Height: 1 u
o
OWN1t�f4r'
yr a �ES" ^;SEE{r
NER/L,ri�
CONTRACTOR
hug exr�y�=,
Name ro IY! 01
Name: I)IVl Sa
Address: I( OIAl!t Dr
Company: W_ �f �IAV.
Address: Q _)') S- filar r Son S�
City: for State: Eli
Zip Code: 3 �1�1 �( Fax: �—
Phone No. c{ (]1 'oL ' ')--q Q
City: T),— tl V`e_f� State: G�
Zip Code:-i U Fax:
Phone No '-IUl qA
E-Mail h f D8 Y
State or County License
E-Mail: y) $
Fill in fee simple Title Aolder on next page ( if different
from the Owner listed above)
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.
SUP�PLEMENTALCONSTRUCTION LIEN LA�W,INFORMATION
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
of Applicable
Name: �
Name:
Address: ")1
S D VI
Address:
City:
State:
City:
State:
Zip: �(�-l0 Phone
�a� •��a�a�u�
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
of Applicable
BONDING COMPANY:
of Applicable
Name:
Name:
Address:
Address:
City:
City
Zip: Phone:
Zip; Phone:
GO 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 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 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 attorneybefore commencingwork or recordingour Notice of Commencement.If 0
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Si ra iare of� ner Lessee, Coritracfor as Agentfor' Owher;
Sign ture nt se Holder
STATE OF FLORIDA�
STATE OF FLORIDA
COUNTY OF / / Y
COUNTY OF_�/� IL
S r to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Pres nce or Online N tarization
this _a -day of� , 202�by
_Physical Presence or �_ Online Notarization
day of 2024 by
o S
Name
Name of person m king statement.
Personally Known —OR Pr ced Identification
of person making state ent.
Personally Known � OR Produced Identification
Type of Identifica ' n
��
Typ f Identificatio
Pro
Produced
Ir
ed
(Sign ure of Notary c- I RY PUBLIC
(Sign ure of Notary ic- State of sso' NOTARY PU
r` �l�" � T T�j} OF FLORIDA
Commission No. �'
� `•• +STATE OF FLO
Commission No. �
a�m# GG973629
�
• s� •� •Comm# GG9
s�yc� �9��' Expires 3/26/2024
M4e �y� Expires 3126
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