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All APPLICABLE INFO[ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: ST, A Permit Number:
SCANNED
I! BY
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St. Lucie County
Building Permit Applica ion IV ® `018
Planning and Development Services
Building and Code Regulation Division ' ST, Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 '
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial d% Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
PropertyTax lD #: 301- � �? -a n a l oCvzl
Site Plan Name: , e-- S' d cz(- n-)
Project Name: C e'YNI O Cvf-rn IC, VI
Setbacks" Front Back: Right Side: Left
_Mechanical : _Gas Tank _Gas Piping _Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: _ Sq. Ft. of First Floor:_
a
Cost of Construction: $ . 7 G�G�C7 Utilities: _Sewer _Septic
Lot No.
Block No. .
Windows/Doors
Roof Pitch
Building Height:
NO, NER%LIE-SSE E:
GO IN TRACTOR:
NameDPW' ' _ LL' hfl a/ .
Name: -
4
Address IA- 00soP,c) 9IZc' ^
1
Company:
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L
I
City: �" (,P_ _ State: f
Zip Code: `4-01 Fax:
Phone No.
Address:
City:
Zip Code:
Phone No
pFaax:-�
State:
-go26 7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail(ni
En�Pr) 3uJ ��
rn
State or County Licensed CjC C-)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPP =MEN:l: LGON A
CTION LIRN LA
1NFORMPTIf3N:
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:
OWNER/ CONTRACTOR AFFIDVIT: Application is herebymade to obtairf 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 roo"ms'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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
igna re of Owner/ Lessee/Contractor as Agent for Owner
SignatGre of Contractor/License Hol e
STATE OF FLORIDA
STATE OF FLORIDA .
COUNTY OF S r . Ly c %-C
COUNTY OF 6 %Y . t-O<, Ok
The forgoing instrument was acknowledged before me
thisday of M91 20� by
The forgoing instrument was acknowledged before me
thi/s%0 day of 20 R by
�
(Name of person acknowledging)
(Name of person
naacknowledging)
(Signature of Notary blic- State of Florida)
(Signature of NotaYy Public- State of Florida )
Personally Known OR Produced Identification
K'
Personally Known OR Prrood®ced raFre`"fi ` ..
Type of Identification
Type of Identification �NAMAtIEGNE'�
GG 022021),#
Produced V i� DEN'INAMARIE GNENS
022023
Produced �L ��`"°y'E'., v ONMISSIONq
16, 2020 '+:
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°{ Y co mbar 16'2020
Commission No. 3t ?.'.r.; �SN
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. //ZU14