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.,PPLICABl.1E INFO MIDST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date:. f�+ f Permit Number: ��J�O� �
Building Permit Application
Punning 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:
Address:
Legal Description:
Property Tax l D## lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
%,yrs �f �"o�z, /U-AW
Additional workto be performed Under this peruffit—check permit—checkall that appy:
"Mechanical —Gas Tank —Gas Piping -�-Shutters Windows/Doors
_Electric —Plumbing , Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft,of First Floor:
Cost of Construction:$_ �/l d_-_ Utilities: —Sewer —Septic Building Height:
Name- 0" �7�c.�P ;f' 'Name: &xr�,15 Sd.�to'�PnonS .
Address 7cya __ r SNSfeMc )ALC_
City:
A C::.--
City: • llabzz -4�4z� _ State: Address: 1415 $1. V1' Dr
Zip Code: ��5:2. _ Fax: Ci i
City: r[�. _ST LtiC e State: L.
Phone No. l�Z aZ4�/b2 /r-� _ zip Code:_ Sd2 .._ Fax:_ qJ9
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: c h r o ).
from the Owner listed above) State or County License: C-AC06 1H l0 - 54n�,P_ '__
If value of construction is 2S8dor more,a RECORDED Notice of Commencement is required.
DfSICNE ENGINEER: Not Applicable MCI AGE COMPANY: Not Applicable
Narhe• Na
.
Address: Address: r
Stat
city. State: e
' Phone:
'p. one: p.
>VIMPLE TiTGE HOLDER: Not Applicable • 06HOIN49 COMPANY. __Not Applicable
Naline:• Name:
Address: Address:
City City
Zip: Phone: Zip: Phone. -- -
OWNER/CONTRACTOR AFFIDVI'T:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or Installation has commenced prior to the issuance of a permit.
St.Lucie Count, makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structure.ctutre.Pleasee consult withpyourr applicable Home
Owne Owfidon and�eivviiew bylaws
deed for any rents strictions ct anss v i may ay apply. such
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida$uildipg Codes and St.Lucie County Amendments.
;rhe following building permit applications are exempt from ufidergoing 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 Re wrd a Notice of Commencement may result In your paying t Nke 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 recordinit your Notice of Commencement.
jSignature of Owner/Agent/Lessee Signature of ContractorA�icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S- -r t_V C 1-a COUNTY OF.'' Lucie
The forgoing instrument was admowledged before me The forgoing instru ent was acknawledged before me
this f f day of-� - , J' by this—�day of -rw ---,20 fS by
Purfts 54�inmons .'ur�7�s S mr042S_
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public stativof Florida) (Signature of Notary Public-State o rida)
Personally Known OR Produced Identification Personally Known ' OR Produced identification
Type of identification Produced Type of Identiiics on Produced
Commission No. ���*�� t M *I� S t0t,2017 Commisslvicom on No. ���. 4!4*1 * '��• �e�
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eaean'°eoar"tNa�j
EXPIS.AP014,20f
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVER
DATE
COMPLETED
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