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ALL APPLICABLE JNFQ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C��
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Date: c , - j _ SCANNED Permit Number: I �� I —
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BY
St. Lucie
County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To.Select from dropbox, click here
PROP.4SEDsINP.R41(W�w°tQC-All 0:NR .:`
Address:
Legal Descriptions 'YiC _) 1—ty F`Ant���
Property Tax ID # u `� Ci,�- {,Cl(j - ` 'A. "i`1���a' Lot No.�_ _
Site Plan Name: Block No:
Project Name:
Setbacks Front Back: Right Side: Left Side:
-DEI'ACED:ASCRIPTION OF•WO;R'K:
`CORU.TfC�:i_R11lI�gh
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ono � to be Performedunder�ecka app y:
VAC GasTank _ Shutters Q Windows/Doors
Electric Plumbing ❑Sprinklers Generator I_I Roof
Total Sq. Ft of Construction: S�" FFttj of First Floor:
Cost of Construction: $ Utilities: Ftof
ElSeptic Building Height:
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i CO.NTRACTOR::
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Company:
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Zip Code: ` Fax:
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Phone No. -�
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Zip Code:
Phone Ni.
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Fill in fee simple Title Holder on next
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from the Owner listed 'above)
State or County License: C,
n vaiue of construction is $z5m or more, a tirrvmvhv Nonce oT iommencemeni is requirea.
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N:STRIJCTION .LIEN'LAjN;fNFb.Ei(V1ATl0iV:. .
DESIGNER/ENGINEER!
Name: I
Address:
City:
Zip: Pho
Not Applicable
MORTGAGE COMPANY: ` Not Applicable
Name:
Address:
City: State:
Zip: Phone:
State:
e:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Pho
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
City.:
I
e:
Zip: Phone:
OWNER/ CONTRACT dR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
i certify that no work or in tallation has commenced prior to the Issuance of a permit.
St. Lucie County makes no epresentation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with an applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult w th your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the gre I ting of this requested permit, I do hereby agree that l 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 perr ilt applications are exempt from undergoing a full concurrenry review: room additions,
accessory structures, swim ing pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNE : Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to you ' property. A Notice of Commencement must be recorded and posted on the jobsite
before t ie first inspection. If you Intend to obtain financing, consult with lender or an attorney before
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Signature of Owner/ Agenti Lessee
Signa re-ce4on,ra or/License Holder
STATE OF FLORI /l��
STATE OF FLORIDA .
COUNTY OF`_�� . l J_ Cc
COUNTY OF . L V
The forgoing instrument was cknowl ed a before me��".ya•,,
this wday of r ' i ' 20" by =�"'� r s
The for Instrument was a knowl dged.before me 7 ► •'/V�7 �,Q
this�Iday of ` 200by
•
(Name of person acknowledging) o
(Name of person acknowledging.51 ) t
14 Z
e.
(Signature of Notary Publijc•
State of Florida) •
( ignature of Notary Public- State of Florida) n,
Personally Known
OR Produced Identification
Personally Known �R Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission Not )t
c=� (Seal)
Commission No{r` LJ 1�1C�, (Seal)
Revised 07/15/2014
REVIEWS
FROM
ZONING
-SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNT
R
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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