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From:Air Re air Solutions,IFax:(600)757-0066 To: Fax: +1 (772)462-1576 Page 2 of 4 17J02/201 5 11.40 AM
ALC APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED +L� �t
Date: ` .'� I J C 1
Permit Num
WED
MCC
Building Permit A ilkati®n DEC 0 2 201
Planning and Development Services pp PER�dIITTINC�
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial
Residentiial
-: PERMIT APPLICATION FOR
To Select from dropbox click arrow at the end of line
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Property Tax ID#: cxl_,�_ C�
Lot No.
Site Plan Name:
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Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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A itiona wor to a erorme under this permlt-c ec a apply:
&VAC —Gas Tank r--'Gas Piping Shutters
Q Windows/Doors
Electric Plumbing Sprinklers Generator
Roof
Total Sq. Ft of Construction: S .Ft. of First Floor:
Cost of Construction:$-2)-)( < ��p Utilities:(n Sewer aSe
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Name
Name:
Address: Company:
City:
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Address:
Zip Code: c j'` Fax: City:
Phone No. ( ;� - L{ ,{tr Stater
Zip Code: Fax: M,_ (
E-Mail: Phone No.
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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.
From:Air Re air Solutions, (840)757-0466 To: Fax: +1 (772)462-1578 Page 3 of 4 i2102l201511:40 AM
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I3ESIGNERjENGINEER: Not Applicable MORTGAGE COMPANY:, Not Applicable
Name: Name:
Address: Address-
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE T!"TI_E HOLDER- Not Applicable BONDING COMPANY: Not Applicable
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.Lucle 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 mayrestrict 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 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 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 Commencement may result in your paying 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 recording our Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Contra or/License Holder
STATE OF FLORA STATE OF FLORIDA,
COUNTY OF COUNTY OF
The forgoing inst ument was acknowledged before me The forgoing instrument was acknowledged before me
this day of o e✓!1�^bp_Z 20 �by this day of 20n IS- by
(Name of person acknowledging) (!Name of person acknowledging)
(SignatufUf Notary Public-State of Florida} (Sign ature`MNotary Public-State of Florida}
Personally KnownOR Produced Identification Personally Known OR Produced identification
Type of identificatio Produced A=tEXULKSKL_ Type of Identification Produced
a , •, ° �o•,,<.'<<a* Co ISSION 4 fF t42732
MY COMMiSSiCN Ff 142732 1� ,
Commission No. �u�7 * ISSOIHES:August 5,2018 Commission No. S:August 5,2018
"r §4� Bonded TnruBWONAVY smkes �aR '` Ban�d1bruBod0NoWySoM1M
,fFOF P4�� off 4
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETA-fiON SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS