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All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
LL� o�Date: J ( Permit Number:
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
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PERMIT APPLICATION FOR:
Address: y� ''
Legal Description: �2 w a,V k L/ l ( ji0 J' I
Property Tax ID#: ! 36 (p (t - C� 3 —C�6 -Z- Lot No. _
Site Plan Name: I Block No.
Project Name: S 0--(_a- c/
Setbacks Front Back: ight Side: Left Side:
Lo
`cQ �cc 6Ua 1&35
Q (� slam
Additional work to be performed un er this permit-check a I I that appy:
_Mechanical _Gas Tank as Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ -716 '277i- jai Utilities: —Sewer —Septic Building Height:
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Name �1;�r Q c/ Name: Y�
Address: ��a LI uS c�1/K �✓ Company: La
City: C_�(' Sta e:'E Address:
Zip Code: 01 Fax: City: State:
Phone No. -7 Z 33 7 Zip Code: Fax:
E-Mail: Phone No. o 2 ��v
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Fill in fee simple Title Holder on next page ( if di7erent E-Mail:
from the Owner listed above) State or County License: �- 5�d
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTALCONSTRUCTION'LIEN LANK IN'FQRMATION
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: S ate: City: State:
Zip: Phone: Zip: Phone: _
FEE SIMPLE TITLE HOLDER: Not Ap licable BONDING COMPANY: Not Applicable
Name: Name: Y
Address: Address:
City: _ City:
Zip: Phone: ( Zip: Phone: _
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I certify that no work or installation has commencers prior to the issuance of a permit.
St.Lucie County makes no representation that is grunting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owne((s Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Ai sociation and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1 will,in all respect perform the work
in accordance with the approved plans,the Florida uilding Codes and St.Lucie County Amendm It
The following building perm' plications are exempt from undergoing a full concurrency revie :r m additions,
accessory structures,swi in pools, fen es,walls signs,screen rooms and accessory uses t ano er non-residential use
WARNING TO OW/NR: Y ur fai re t Reco d a Notice of Commencement may r suit' your paying twice for
improvements to pr per . A N tice f Commencement must be re r.ed a d post n the jobsite
before the first inho . i you int nd to�btain financing, consult with { der o an a am y before
commencingwarrec din ou Notic of Commencement.
// I If V I
Signature of Own /Agent/Lessee Signature of Contr for/License Holder
STATE OF FL IDA STATE OF FLO DA
COUNTY OF xNGE COUNTY OF vu +cs
The oing it strume acknowledge fore me The forg ing ins um w knowledged e me
this day f 20 by tftis day o 120 � y
PETER A CAFARb III PETER A CAFARO III
(Name of person acknowl (Name of person acknowle ing j
( ignature of Notary Public-State of F orida} (Si nature o Notary Public-State bf Flor da }
Personally Known x OR Produced Identificati n Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. EE I74I64 mmission No. EE 174164 QTp I ea(,
o Not TGc State of Fio qa {
o Y pL'4 Notary Public Stale of Florida q ��
Kari M Riccaboni Kari M Riccaboni {,
��Q� £E��, ac to CcrnmissinnEE 174IG4
of st° Expires 0512612016
Revised 07/15/2014
} �` � xpi+es 05728 20th .. ^r.
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