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ALL APPAB E 1 FO MU TBE COMPLETED FOR APPLICATION TO BE ACCEPTED �r
Date: Permit Number: /�6 J �t
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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 arrow at the end of line
ROP(?SED�IMPROVEMENT,,LOCATION::
Address: 11,15 C L)c1�1T—I�1N—� • �[PXC�-
Legal Description: _(' pt,, 4hN [V\��Q� 51th S`Y-, ?A 0± IS
Property Tax ID#: — Lot No.
Site Plan Name: Block No.
Project Name:
-Setbaeks FtenE 4ac-le +Nght-Side: Left-g4de:
DETAILED DESCRIPTIONOF WORK
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CONSTRUCTION INFORMATION
Additional wor to be nertormed under this permit—check all apply:
HVAC Gas Tank Gas Piping _Shutters a doves/Doors
Electric ❑_Plumbing Sprinklers 1:1 Generator _Roof
Total Sq. Ft of Construction: TW 31 r:
Cost of Construction:$ �tbig "F _Sewer[ISeptic aw4ir►g-tfeigFrt-
OWNER/L8S;EE: CONTRACTOR :
Name Name: �p
Address: \��ZS CAo�I {/\ Company: 1�q V1C
City � LQ_ State: Address: _Q
Zip Code: 3!q�t�J Fax: N f P�c City: _9�R ak Stater
Phone No. X112-Qfg24lZg Zip Code: 34q1 1 Fax: fVd-
E-Mail: N1Pc Phone No. '2 2 2-01 35-2
Fill in fee simple Title Holder on next page(if different E-Mail: \
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.
{SI,PPLEMENTAL CONSTRUCTION LIEN LA1N INFORMATION r
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DESIGNER/ENGINEER: _Not Apple MORTGAGE COMPANY: _Not A
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _No icable BONDING COMPANY: Not A
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 Commenc nt ay in your paying twice for
improvem s to y pro otice of Commencement st be re rded a d posted on the jobsite
before e first i . I u i end to obtain financing onsul lender r an attorney before
com en 'n re n r Notice of Commence/hent.
oel
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Si_ ure of Own N'-_ see/Agent Si /License Holder
STATE OF FLORIDA b STATE OF FLORIDA
COUNTY OF ` fie— COUNTY OF ZEE Lu C'( '0_>
The foroing instrument was cknowledged before me The forgoing instrument was acknowledged before me
this day of 20 1�y this_day of c5 exp l 20 J,6_by
1� mac'
GoUktX-SCrr',e,�7�P� .� D �',� s
(Name of person acknowledge ) q (Name of person acknowledging)
Y 'S4LJ Ute.
77qq_431-,0—/Y"-,
a of �,o Y+ti.$tate (Signature of Notary Publ c State of Florida)
ANGELA '
Personall `�. m ffPNr�u �'d4fhen �`on Personally Known t� R �rA
o Identific ion' Pd ommisston o Ftortda Type of Identification Pro `O�s%
Bnnd ExAJres Ma e•. Notary Public-State of Florida
edthroug Y?7.2019 Commission li '�'
Commission No. atlyolAssn ,Fo„`opc;: M)' i�sion Expires Jan 4,201
Commission#FF 074781
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS