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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S�Lro L�UP.CHL ,h
FN
RECEIVED
Building Permit Application MAR
Planningand Development Services i 5 Z�z2
St
Lucie
Co
Building and Code Regulation Division Commercial Residential e
. unty
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: ,
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P.ROROSED IMPROVEMENT.LOCATION:
Address: -T-2 (o QoaA
p� d
Property Tax ID#: I ` �( 1 I: (Don , Lot No. 3
Site Plan Name: Block No. (t(O_
Project Name:
DETAILED DESCRIPTION OF WORK.'
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORIVIATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters -Windows/Doors _Pond
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Electric _Plumbing _Sprinklers _Generator Roof Pitch
ll__
Total Sq. Ft of Construction: I �J Sq. Ft. of First Floor:
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Cost of Construction: $ E100 Utilities: _Sewer Septic Building Height:
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OWNER/LESSEE C4NTRACTOR:
Name_77ayi6 r Nam 1� o
Address:__�__10(o �0.�P.✓V1L� P—Q Company:`�c��r1�,�.,
City�U- Pi e ree— State: FL Address: 103'5
Zip Code:{Sq-q f5 I Fax: City: Stater
Phone No�3U5 —]lQ l c`��(��j E- Zip Code: Fax:
Mail: - V_GneJ1'-• C�ar'IYeJJ g�gWC .l. Caws Phone No A&'35
Fill in fee simple Title Holder on next page(if different E-Mail :5 1 'C=C C.�ss; 9;VO4 'c-orz
from the Owner listed above) State or County License Soe_
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMAT(QN
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:
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 Amendment's.
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 CQAty and posted on the jobsite before the first inspection. If you intendito obtain financing, consult
with-en or an attorney before commencing work or recording our Notice of Commencement.
Signature of ntractor-or-Owner Builder as applicable
STATE OF FLORIDA \_
COUNTY OF 1n\ aYY\1 1��[
Swornor affirmed and subscribed before me of Physical Presence or Online Notarization
this t day of 2C��by
Name of person making statement.
Personally Known OR Produced Identification ;
Type of Identification Produced
(Signature of Notary Public-State of Florida)
LISS97E MARY ALVAREZ I
Commission No. (Sea1) •:4� `,%. Notary Public.State of Florida
Commissibn HH 0159g6
�'� off' py Comm.Expires jut 26.2024
•..,of ry:." Assn.
bonded through National Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21
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