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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5\%NIP- Permit Number:
RECE1'."7 D P,W 16 2016
•
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
PROPOSED�IMRROVEMENT1OCATION; - Y ;
Address: .
Legal Description:
PropertyTax ID#: Lo A'�
Site Plan Name: Block No.
Project Name:.
Setbacks Front Back: Right Side: Left Side:
%DETAILE'D.D.ESCRI`PTION OF'VIWORK:, -
�w AaA� 2V IH-e- V u gYMAJL 0)Y\vers1'LYV1 .
CONSTRUCTION IN.FORMATIO.N
Additional work toa erorme . under this permit-check a appy:
HVAC0 Gas Tank ❑Gas Piping _Shutters Windows/Doors
\IaElectric O Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
L
Cost of Construction:$ LQ W� Utilities: Sewer Septic Building Height:
01NNERLESSEE CO`NTRA�CTOR:'
Name Name:
Address: \Qr) V_�V�f OQ Company: R
City: '� State:g Address: tbl
Zip Code:��,_T n SL Fax: City: Staterr
PhoneNo. -��JZ- (pip�p Zip Code: �7 �— Fax: —LkP I=) tP
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail• 5
from the Owner listed above) State or County License: Lp�3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
_Signatu e. Swner/Lessee/Agent Signat C \ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIQA
COUNTY OF 5 -$r. COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day ofd•�l 20by this day of 14Ncl.y 20 —\Ib—by
)d..q`a 't'`d'Co `� moo. wNt S Yha."r J\cii�-
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub' -State of Florida ) f>' (Signature of Notary Public-State of Florida)
,�- ,\`1�NS �6 r:, ��vENs�
Personally Known OR Pr ,duke✓- �ld� tfitati� Personally Known OR Prgd6dc N"1 nt�Fb�a�iq�2
Type of Identification Produced 1�% ���e°,a�6� Type of Identification Produced L �C - este° 616
Commission No. ^ e yG°��;(Seal);n° Commission No. °pQ
F(`! puny
Revised 07/15/201,4......: r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
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