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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O . v Q
Date: -I - \r\-1 Permit Num V w = s"VMWw .r
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:
�c
JUL 1 2019
Building Permit Appl T& tting Department
5t. Lucie County, FL
Commercial Residential
Address: W64 Oer�nqp— R-- t'ienrc-F'--T1. Z�AQA5
Property Tax ID #: C43k1Q- ate" cccl k - C — 0
'Site Plan Name:
Project Name:
I
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: (� jyl� Sq. Ft. of First Floor:
Cost of Construction: $�Utilities: —Sewer _Septic
City: �c'at State: LL
Zip Code: 1 0�; Fax:
Phone No.-Ta �y�D 1 �PkU
E-Mail: CJ 0.01-001'y—
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Lot No.
Block No.
Windows/Doors
Y— Roof Pitch
Building Height:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
'P E� ESN CO ST'
CTI�O Ll�� W
'O T O
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
IiOWNER/ 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,
jaccessory 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
i TWICE FOR. IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
J g 6��t
Signatur of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDO -
STATE OF FLORIDA
COUNTY OF �I�i�/Lt�
COUNTY OF
The forgoing inst nt was acknowledgg efore me
The forgoing instrument was acknowledged before me
this ( day of 20/4by
this day of 20_ by
c n-
Name 6f person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Iden i 'rat' n -
Type of Identification
Produced C -
Produced
(Signature of Nota ublic- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. AUDREI(!lMOMPHREY
Commission No. (Seal)
MY COMMISSION # GG $00817
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nded Thru NotW Pu
lic jj de; iters
REVIEWS
R
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19