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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: V\6ct • dm3
RECEIVED
AUG Q 2 1'9
Building Permit Application
Permittmc Lucie County,
Planning and Development Services ST. -
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: 462-1578 Commercial Residential
(772) zl'-�
PERMIT TYPE:
Address: S bra" / P ✓Le 3U
Property Tax ID It: a`�12�a'dd 2, ' d 0 ' �00 - �c Lot No.
Site Plan Name: Block No.
Project Name:
>DE7AILED DESCRIPTION OF WOR
e4 -Q She w
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Additional work to be performed under this permit - check all that apply:
fAolechanical _ Gas Tank — Gas Piping —Shutters — Windows/Doors
—Electric —Plumbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
Name / Name: rl S ect
Address: G r1A le --�> Company: Q_ S
City: — ) l 0VCO State: - Address: ��� 3 Z/✓ 3 y1 l h�/ P
Zip Code: '&-4 Fax: City: Stater
Phone No. 7 7,2- 7/ / Z-F Z Z Zip Code:y 4fc Fax:
E-Mail: Phone No �(=L CC 72Sn 7 0Cr
Fill in fee simple Title Holder on next page ( if different E-Mail E rn LAO r t 2( r R k O O
from the Owner listed above) State or County Licenser kl C (8 / 2 O �"
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.
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y UR NOTICE OF COMMENCEMENT."
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Signature of Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLOTA
COUNTY OFs l - LJ�
COUNTY OF -V.
The forgoing instrument was acknowled%l before me
The forgoing instr ment was acknowledged before me
�J
this ILday ofQS1� 20_ by
this i day of air 20 IA by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced ik-L
(Signature of Notary lic-State of Flo aA�yttch'- ,
,;(Signature of Nota Public -St
NAMitit
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Commission No. M1f � 'eta ns "E�•
SK�n
���' DU�i C� 022U25
.Commission No. ': MY ��„ser�=�16 '72`
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SUPERVISOR
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