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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: p d�
A ril 14,2017 Permit Number. 1-7
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Building Permit Application
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (7,721462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEME T LOCATION:
Address: 12 Lake Vista Trail 203 Port St Lucie
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Legal Description:Vista St.Lucie Building 12 Unit 203
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Property Tax ID#: 3422-500-0164000-7 Lot No.
Site Plan Name: ii Block No.
Project Name: I
Setbacks Front BI ack: Right Side: Left Side:
DETAILED DESCRIPTION F WORK:
Install hot and cold water lines overhead to washer hook-up
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[CONSTRUCTION INFOR ATION:
Additional wor toa Orme pe
un under isrmd-checka appy:
HVAC 0Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric Lr l[Plumbing Sprinklers 01 Generator Roof Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ 600.00 Utilities: Sewer OSeptic Building Height:
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OWNER/LESSEE: CONTRACTOR:
Name Maureen Golder Name: Gary W.Zanello
Address;12 Lake Vista Trail203 I I Company: port St.Lucie Plumbing
City: Port St Lucie State:F" Address: 69D7 Heritage Dr.
Zip Code:34952 Falx: City: Port - Lucie State:FL
Phone No:772 879-9604 Zip Code: 34952 Fax: 772 489-9126
E-Mail: I Phone No.772468-6524
Fill in fee simple Title Holder an next page(if different. E-Mail: Po
from the Owner listed above) State or County License: CFC058025
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNS ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name*
Address: Address:
City: State: City: State:
Zip: Phone: I Zip: Phone:
City_
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Zip Ph
SIMPLE TITLE:�
HOLDER-.
FEE SIMPLE TrrLE HOLDER-. Not Applicable BONDING COMPANY: Not Applicable
e.:
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Na 7 Name:
me,
[Address: Address-
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City:
1 . Zip: Phone:
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Zip: Phone:. I
I certify that no work or installation has commenced prior to the issuance of a permit
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St Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
conflictwhich isinwith any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with youir Rome 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 IWill,In all respects,perform the work
in accordance with the approved 'Plans,the Florida Building Codes and St.Lude County Amendments.
The following building permit applications cations are exemptfrom undergoing a full concurrency review:room additions,
accessory structures,swimming p iols,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:You y failure to Record a Notice of Commencement may result in your paying twice for
improvements to your propfirty.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
comm nein work or recorilting our Notice of Commencement.
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�&/Liee-rise older
iraffpi of r%orer/66ssee/Con ctor as Agent for owner S�Ign COWC.
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF st Lude COUNTY OF-Lv-
The fo� inginstrun3entwas ackLwledged before me The forgoing instrument was acknowledged before me
1 -11 day of - .2o 17 by
%Prl/ ' , 20 ZZ�y A //
this_dayof
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Gxy w.Zar*410-L I GMMZM�R*
(Name of person acknowledging) (Name of person acknowledging)
6Lr��
AVMJk- -
(Signature of Notary Public- to of Florida) {Signature of Notary Public-State cylorida
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Personally Known x duced Idellf
Personally Known x OR Produced Identification
— Zed
Type of Identificat Type of Identification Produ UIMI.,. -
FFMON
Avowd 25,2M9
NO FMI09
Commission Commission No. FF8011X9
WRONNOTARYMM
OF
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Revised 07/15/2014
REVIEWS FRONT LVINUM3 SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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Port St. Lucie Plumbing, Inc.
6907 Heritage Dr.
Port St. Lucie, Fl 34952
772 468-6524
(Fax) 489-9126
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Date: April 20, 2017
To: St. Lucie County
Fax: 462-6443
Attn: Eileen
Re: Water heater permit
12 Lake Vista Trail Unit 203
From: Dee
Thanks
Number of pages including cover sheet: 2
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