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Planning I I Development
Building and Code RegulationDivision
2300 Virginia Avenue,Fort '
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flt-io—n—al work to b rf rmed under this perrWit—check all that apply:
0 HVAC Gas Tank F_]Gas Piping Shutters 12�winclows/Doors
Electric Plumbing Generator
9 Sprinklers 1:1 Roof
Total Sq. Ft of Construction: S Ft of First Floor:
I Utilitiescin
12 316- 36
Cost of Construction. —Sewerl:]Septic Building Height:
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If value of construction is
00$25RECORDED
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 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 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
_Signature of essee/Agent Signature of Contractor/License Holder
STATE OF Fr
STATE OF FL RI
COUNTY OF COUNTY OF
Tmgrqoinginstrc>�nt was acknowledg?d before me The pping instrument was acknowled before me
da'of 20 ' i thda'of 20 b
l
(Name of person acknowledging) (Name of'person acknow edging)
6 f2) ��N
(Signature of Notary Public-State of Florida) ( ignature of Notary P lic-State of Florida )
Personally Known v OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced pe of Identification Produced
COMMISSION#EE 855825 /
Commission N O� �` e@ mmission No. _ / Seal
IRES:December28 2016 S
-': ��h Bonded Thru Notary Public Undenvrd
,,oti Y e MELISA ARMENTO
Revised 07/15/2014 .• a EXPIRES:December 28,2016
ide Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
CO M P LETE
INITIALS