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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: T� Permit Number: 03'U 31 S
BY
F- St. Lucie County
Building Permit Application eivvr
Planning and Development Services MAR 13 �Q19
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential' _ aunty, Permitting
PERMITTYPE: r
PROPOSED IMPROVEMENT LOCATION:
Address: '�5��' to- �•�€ (�
Property Tax ID #: a yD 5-Coa )� C1I�O�C a00-d Lot No. t7 1�r-7
Site Plan Name: N(o. b �'5 Block No. 2-'d-
Project Name: 1� 2!W
DETAILED DESCRIPTION OF WORK:
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
v Iectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:
,t //
Cost of Construction: $ t%I a U')
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
tj f( f4? 6Cet
Name: STE"C- fir;-E'')
Address: 3
Company: 04Ur2prx I?c-� ue-
City: _t�c i r%r-f , (_State: ,
Zip Code: `3 �I�j�/� Fax:
Phone No. ]ri -(043 �(30�
Address: c o3S' Al ` 6erc t 14— X2 9
City: ��r State:_
Zip Code: '� mac/%/( Fax: e -
Phone No
(��
E-Mail: —i'r
ILL2(g. eab a Fed(. CdV—
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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.
Not
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phon(
_Not Applicable
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, Twalls, signs, screen rooms and accessory useess,�,'ttooTanother
rnon-residential use
"WARNING
MAY
M-1)Y YOUR PAYING
TWICE FOR
VRECORDED AND
EMENT
POSTEDUR 'i E JOB R IAN AEATTORNEYE FORE RECORDING
. IF Y.NOSi OF TO OB AA� B NC NG, CONSULT
Sig wner/Lessee/ ontractoras gent for Owner
Signa" of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY
COUNTY OF Sk• Loc��
OF 6 k.
The forgoing instrument was acknowledged before me
The forgoing instrument wasacknowledg; before me
this day ofN^INrh� 20Aby
this\3 day of i�d r 201 � by
Ca
GC -v� c -rN d J c -Ir
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification
�—
Produced cr L' 1b
(Signature of Ns 1
mucitdISStoN # GG 0220='-
(Signature of Notary blic-St OmgsNs0�3 1
Commission
GFNI� j
td1SSIGN # GG 20
Commission No.iS = ~ .... r GMN(e�-
S
:Decembe(5Effi}
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REVIEWS
F NT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19