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All APPLICABLE INFO MU/ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / / Permit Number:
.r OCT 18 2016
Building Permit Application F2z,—R•4;ITTiNJG
Planning and Development Services St. Lucie County, FL
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:
P �OPOSED INRROVEMElUT LOCATIQN:
Address: 10;7 ce4r) ,X'Y;1 eoje4 4Jea,,4 A1.3YFy-7
Legal Description: Q��� a'/ Qvt" c7.-f 3-t I'le-le 73 7)
01
Property Tax ID#: ��/ ' -0n) -(910.� Lot No.
Site Plan Name: d/ (/yf Block No. P
Project Name: '07
Setbacks Front Back: Right Side: Left Side:
DETAILED DE1S 1112TION I's WORK:
COM v e Ilefiolillon G1j2 f-p--oveil 0/" e
MT ®rim
N INFORMATION:
Additional work to ape Orme under this permit-c ec all that appy:
_Mechanical _Gas Tank —Gas-Piping _Shutters _Windows/Doors
Electric _Plum .f
fbing _Sprinklers _Generator Roo
,
Total Sq. Ft of Construction: `l�V Sq. Ft.of First Floor: 70
Cost of Construction: $ 1 7,9Q•do Utilities: Sewer _Septic Building Height:
O�WN!ER/ILE�S�S, E C®NTRACT®'R: F
Name Zkc C C A,n e'�/ Name: i
.Address: ,leve -3 Qi ;coni pan ��O/ � 1r&C.
City; ,S jRyear�lL State: /cAddress
Zip Code:. 3 yy�� Fax: City:°>: e.:,.B : c-a State:/CL,
Phone'No ���" 3Y - F033 Zip Code:3 /9� Fax: �72'Z3.2
E-Mail: Phone No 7 7 3 715-
Fill
/SFill in fee simple Title Holder on next page (if different E-Mail a qM $'moo f/ ;%7 C &2?y¢o/op.ce.4"
from the Owner listed above) State or County License 679/8/
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJ RUSEIVIENT/A�C®NSTR�t1CTl,®N LIEN 1 41N INiF®'RMATIO'N
DESIGN ER/ENGINEE _ Not Applicable MORTGAGE COMPANY: Not-Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE_TITLE HOLDER: _Not App ble BONDING COMPANY: Not Applicable
Name: Name:
Ad d ress: Address:
City:
Zip: Phone* Zip: Phone:
OWNER/ CO TRACTOR AFFIDVIT: Application is hereby made to obtain a Rermit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a perm'
St. Lucie County makes no representation that is granting a permit will authorize the per holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and cove is that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any re ictions 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 wor ,orj.ecorclintLce of Commencement.
Signa re of Owner/ see/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I'll COUNTY OF
The fo�,,rm� ing instrument was acknowledged before me The fing instrument was acknowledged before me
this�day of CC4®�St� 201Vby thisday of 20 Ko by
AA rA vv� smPy- "
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identif Type of Identi cation I
ion�t ,� �
Produced C_ Produced G_Q����//��T�
el
Commission No. v (SL(IffflERLYA.WALKER Commission No.�C CeMl L (SOAAIBERLYA.WALKER
NOTARY PUBLIC t NOTARY PUBLIC
STATE OF FLORIDA IF14 r_ IF IF-STAT r =1 ORIDA
M#FF089371 m#FF089371
REVIEWS FRONT Ex rElEl� {� PLANS VEGETATION SEA'WW E8
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW RE
DATE
RECEIVED
DATE
COMPLETED
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