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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 lac Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: n X .
RECEIVED
FEB 2 6 2021
Building Permit Appkati®n Permitting D'aaartment
Sh, Lucie, County
Commercial
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
Residential
Additional work to be performed under this permit - check all that apply:
%Mechanical_ Gas Tank _ Gas Piping _ Shutters
-)alectric 1y Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: J at Sq. Ft. of First Floor: _
Cost of Construction: $i� t 01,'0fc) Utilities: —Sewer —Septic
cS
Lot No._
Block No.
Windows/Doors
Roof Pitch
Building Height:
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Name---•�..
Address 6[t4 ct
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Company:
City: State:
Zip Code: q S( Fax: �_ _
Phone No. --a
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Address:^ A
CState:
Zip Code: ` `-' ""=` < Fax:
Phone No
E-Mail:
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Fill in fee simple Title Holder on Aext page ( if different
from the Owner listed above)
E-Mail
State or County License
if value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE .DOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
YOUR NOTICE OF COMMENCEMENT."
wiTH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
XSignat �gentor
Signature of Contractor/License Holder
re of O ner/.Lessee/Contrac Owner
STATE OF FLORIDA
COUNTY OF Sac �—V ��'�
STATE OF FLORIDA
COUNTY OF
The forgoing instrume was acknowledged before me
this-44 day of 120 by
The forgoing instrument was acknowledged before me
this day of , 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Type of Identifi ation
Produced
Personally Known OR Produced Identification
Type of Identification
Produced
of Notary Pu lic State ) DEANNA GIVEN
(Signaturey :'1', Notary Public . State o
Commission No. ` Commission ; HH 0
I) My Comm. Expires Jan
Bonded through National No
Sin ure of Notary Public- State of Florida )
=i na
6359 (Seal) ,
2�QNG8 Sion No.
ary Assn.
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.