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,PPLICABLtE;INFO MUST BE COMPLETED FOR APPLICATiON'TO BE ACCEPTED e1
Date: Foey`/5 Permit Number:
SEP 211015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Plerce FL 34982
Phone: (772)452-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: V
Address: � / h7lccl,�,tc2� '
Legal Description:
Property Tax ID#: +� a7� J�' ,�� � Lot No. _
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: _Left Side:
L./��� /��.� Ll1r� �? f��✓ti ( e n c. g X7
Wn�ZPawor o epe rme un er t is perms —c ec a tat app y:
, echanical _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:$ $�FrO Utilities: —Sewer _Septic Building Height-
Na 7 �t � Name: CcLrtl5 S o
Address: eZ���7/ Sly �'� Company: A'r
Stater Address: 11 15 S�- `ll i i(a.a -.fit
r
Zip Code: '3+J"v-t_ - Fax: City: Pour aT Lkc ie_ State: L-
Phone NQ. zip Code: �4 q5% Fax: --
E-Mail: loo . Q?•D1C07P0 Phone No. 7z 33,5 3�3
Fill in fee simple Title Holder on next page(if different E-Mail;
from the owner listed above) State or County License: W061,910 - s4a��P_
if value of construction is ZWTar more,8 RECORDEp Notice of commencement is required.
LLD
DESIGNERANGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: : Address:
City: StateCity: State:
Zip: _ Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: `Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip:. Phone:
OWNER/CONTRACTOR AFFiDVIT: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 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
iri accordance with the approved pians,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 S Notice of Commencement may result in your paaying 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 recorftg your Notice of Commencement.
I �_ V" , —_I
31 -
'Signature of Owner/Agent/ essee Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF u c, COUNTY OF
The for instrurnent was acknowledged before me The forgoing instrument was acknowledged before me
this day of � - 20� by this.�L day of .20/lby
(Name of person acknowledging) (Name of person acknowledging)
lop
Signature of Notary Public-Stapfof Florida) (Signd'ture of Notary Public-State Fiorlda}
Personally Known V OR Produced identification Personally Known OR Produced idenfiification
type of Identification Produced HType of identlflcation Produced
IutY COMM14N 4 EE M1 294 oik� Ci1RlS11NE>k ENC,11%
Commission No. � * �I EXPIRES:April 4,201 Commisslon No. ,s MYCQMMIs5I0N4E 592
' r� Bonitwdlfw8udp�iRaary9 ces * EXPIRES:April 4, 047
' ,. ��vl,a0 P��`or Bctida�llt�BudgetN, 6svit
REVIEWS FRONT ZONING,. ' SUPERVISOR, PLANS VCGSTATION SCA TURTLE MANGROVE
COUNTER REVIEW REVIEWREVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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