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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACC&, cD �
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Date: f Permit Number: I v�
SCANNED
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Building Permuil Application p
Planning and Development Services Pnitf/ yr ?9
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Building and Code Regulation Division <Uc�y9�Pp��''e''��p
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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PERMIT TYPE:
C) awRUN
Address: aoi St Cq m%rlb52-
Property Tax lDM R-115-5-IS-()2-7 now-1 Lot No.
Site Plan Name: Block No. 3 �—
Project Name:
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Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing Sprinklers _ Generator 'A —Roof Pitch
Total Sq. Ft of Construction: I iJ C/ �`I Sq. Ft. of First Floor: 30E) FIA-f
Cost of Construction: $ ] 31c> 0 Utilities: —Sewer _Septic Building Height:
Name_ f"ie.� S n�j P f� . �oS'Ci
Name:�.. �AcI( k N'ik'..�
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Address: c��'I �F CQMin0 SA
Company: 3 IR-e t.
City: &'rkSC.:nk r4c."e State:FC_.
Address:l&t aCIe=S
City: P o Sk ScOkr* I'Lcei<- State:�L.
Zip Code: 3 L(1 30- Fax:
Phone No.
Zip Code: 'SK` 91 Fax:
E-Mail:
Phone No-11 d- -a-II 75l s
Fill in fee simple Title Holder on next page (if different
E-Mail S (Ao f -k%\ $ bl- q 4\ 00. co.vt
State or County Lice nseCGC.(33 0
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value ofHVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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 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 YOUR NOTICE OF COMMENCEMENT."
&�RLAI A�r
Signaact'),_2
ture of Owner/ Lessee/qUpctor as Agent for Owner
Signature of Contractor/Licens H Ider
STATE OF FLORIDA
STATE OF
OPW
COUNTY OF 1 YcYLI1
COUNTY OF CiR �ll
The r oin instr ent was acknowled g efore me
this }�lc
The oing instr was acknowled @ before me
thisUdayof 201M by
I .2-Mby
II
Name of person making .
Name of person making statement.)
gsstatemen
Personally Known V OR Produced Identification _
Personally Known v OR Produced Identification
Type of Identification
Type of Identification
Produced
h c (1 tfl�mt
Produced
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(Signature of N ry Public -State of Florida'jvoug, BRANDYM(%gaature
of No ri Public -State of Florida )4µYPu BRAN
^n �I Commiselon
Commission No. o _8 I ` Expires M
GG102839 (7 44
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2///19