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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: V2 cf__ Permit Number:
0
RECEIVED
Building Permit Application qR 2 g 2022
Planning and Development Services
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19t.Lucie Cou
Building and Code Regulation Division Commercial ;Residential Permitt
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)4624553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Address: ]mil 1 N I1� r� Gi 66vJ `J
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Property
Site Plan Name: �i! �''1 �3iQ�41 Cp(! 14 S t�N i� Block No. .7
Project Name: /V19•�w
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D %TiD SeiLry
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New E ectrical Meter Second Electrical Meter (Aff%davit requireid) Lt/(• �' /'i7
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Additional work to be performed under this permit—check all that apply: XWAlinclows%Do'o'r"s
Mechanical GasTank Gas Piping Shutters ' Pond
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_.Electric ,Plumbing _Sprinklers Generator _Roof; f1 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floori
Cost of Construction:$ 1_12,06. ob Utilities]' _Sewer _Septic ,. Building Height:
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Name
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Address:. 7O / A. At :.,:Company:
City: ��C.��l� � 7 State: z. Address:
Zip Code: Fax: City: State:
Phone No. 9C—LI aC7_— s'�g Zip Code: Flax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
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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: _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 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 attorney before commencing work or recording our No ce of Commencement.
'IVA
Sig ture of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
KAREN S. NIELSE ,
`��p,AY
COUNTY OF 5t. WCA6 ;2� a°:State of Florida-Notary PL.
�� -' *_ Commission # GG 207z.
Sworn o r affirmed)and subscribed before me of Physical Presence or °lot�diF�nmission Expir<
��rrrr��"'\ June 12, 2022
this day of Mardh 202-2.by
Name of person making statement.
Personally n n R Pro uced Identification
Type of Id ti 'cati orn d ed +'�- iDO �CQr1St
nature of Notary P lic-State of Florida otpR
g y ) oa oy NOTARY PUBLIC
-STATE OFFLORMA
Commission No. C'�C'125�o�(oq (Seal) o 0
a Comm 069
#GG 256
�S�NCE-0 Expires 9129/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURT,LE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 21