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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y
Date:(YS/A Permit Number:
RECEIVED
0 JUN 2 8 'D19
Wilding Permit Applieat Fb�nLueie bounty, Permitting
Planning and Development Services -
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1555 Fax: (772) 462-15713 Commercial Residential_
Property Tax ID#: (Liga ()nn,� O Lot No.
Site Plan Name: Block No. 3
Project Name: Ver-se `► PV
...
LED DESCRIPTItaNOF WORK. �` .
r-
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
XElectric _ Plumbing Sprinklers
Total Sq. Ft of Construction: 305. ��
_ Shutters _ Windows/Doors
Generator , Roof Pitch
Sq. R. of First Floor:
Cost of Construction: $ 1-4-QuD Utilities: —Sewer _ Septic Building Height:
O.WNERAESSEIc
CONTRACTOR
Name a e e`
Name: �i (i
Address:,9I )3 arA 18
Company: i
City: _T-r+ 'PL LL State: Y—L
Address:
,
Zip Code: ��qy� Fax: �/d
City: _Lrkt:
State:
Phone No. - a� I O
Zip Code: 3PI4b Fax:
,1J
E-Mail:
Phone No't59 -PJJL1 �
Fill In fee simple Title Holder on next page ( if different
E-Mail � e bbnclv
from the Owner listed above)
State or County License_` C,I.3M
5-7 y
.\ .Y.YC Y. bVUJu YYYVO W vr. w Y\ o\\YI Q, Y nr.%.wnu&" numve ur wmmencement is required.
If value of HVAC Is $7,= or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN, LAW INFORMATIONS
DESIGN R/ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: I
Name:
Addressees (.J S;- d 4
Address:
City: LO
Zip: 1 Phone L(Ol-
S ate•
7
City: State
1'R
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
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 YOUR PAYING
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 INT D TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RIECO
DING%YWO NOTIM OF COMMENCEMENT."
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Signature o n r L Contractor as Agent for Owner
Signature of Co tractor/License Holder
STATE OF FLORID
COUNTY OF m�n6
STATE OF FLORID
COUNTY �nnL2
OF
The forgoing Instrument was acknowledge before me
this 2� day ofMr)P, . , 20 I� by
The fo oing Instrument was acknowledged before me
this T day of 20ft by
&_skk 2=L4
Obbrc i i-' 6
.o
_ 14nl
Name of person making st tement•
Name of person making atement.
Personally Known OR Produced Identification--k--
Personally Known >,�_ OR Produced Identification
Type of Identificati
Type of Identlflcatlon
Produced L
Produced
f'A
(Signature o of Pub - St Ri 9901 of Florida
(Signature of al IM"
210
Commission No. 0412 es7
comwiew Gc 09aes7
Commission No. 04'
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