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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i,;)- l 17 Permit Number:
R r,�+� E� e7
•
Building Permit Application DEC 0 6 2017
Planning and Development Services PI=W.411TING
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Cl N�-'c�leS I lu(J, erl �n 13eucl, FC.
Legal Description: Nt(�-IcIes17!, ncd�►�1C • p- COndo-SeCL_z_(A, II 6aW-Cel (p'lC11 ccnCl
SVove. 'sn 0ov-Antic*1 C levy eA !' or Cl 15 -I-l( ; 30 7(.* -6 14�
Property Tax ID#: Lot No.
Site Plan Name: , r 1 Block No.
Project Name: V 0.dl a-e ✓ Z w CL Ck� S -
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: `
n �(-K((tic h cin q l•e �'od�
71:� slvt( ► anew q xb le-
CONSTRUCTION
eCONSTRUCTION INFORMATION:
Additional work to be oerformed under this permit-check a appy:
HVAC Gas Tank Gas Piping _Shutters Windows/Doors
❑ ❑
Electric ❑ Plumbing Sprinklers ❑Generator Roof (" Roof pitch
Total Sq. Ft of Construction: (.0o Sq. Ft. of First Floor:
Cost of Construction: $ j �D�f Utilities: 0Sewer Septic Building Height: f Y
OWNER/LESSEE: CONTRACTOR:
N a m e \J CL V,_ v' 7 w c-a-C'X S t ° Name: •SQ nwl
,i
Address: :Y� VK-FS Company:TA k.t
City: z'e'e-kavcd State:M=: Address: 3�1 `5�F '0an+vt ;eck. E_Yr
Zip Code: Lf Q(4(aq Fax:(of(o3Qly 77tp3 City: Swear( Stater
Phone No.(.o( to $31,0 S_7 (o f Zip Code:34 C(9-1 Fax: -1-1 a-X1}S-033
E-Mail: � Li 1 2GZD C -,Y-"\ Phone No. J- q-O 30
Fill in fee simple Title Holder on next page( if different E-Mail: e•k 2a G� �c a�Y-0ajrn2�5.156-M ne
from the Owner listed above) State or County License:_ VClcllri cl G` (CC
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 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:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 Buildin Codes and St. Lucie County Amendments.
e wing building permit applications are exempt from u rgoing a full concurrency review: room additions,
acc ory ructures,swimming pools,fences,walls,signs,scree ms and accessory uses to another non-residential use
WARNI OWNER: Your failure to Record a Notice of C nce nt may result in your paying twice for
improveme to yo property. A Notice of Commenceme m t b ecorded and posted on the jobsite
before the firs spect n. If you intend to obtain financing, c nsu i lender or an attorney before
commencing w or recVrding your Notice of Commencemen
Signatu a of Owner/Lesseeon for as Agent for Owner S gnature of Contractor/Lice e Holder
STAT OF FLORIDA _ S TE OF FLORIDq� t � \
COLIN OF CO TY OF ��J�
The forgoing ins ument was ckn ledged before me The forgoing i ment was c edg�d�efore me
this��ay o 1Tr-1 20D by this Aay of 20 't by
Name of erso making statement ame of p rson making statement
Personall Known OR Produced Identification PersonallyKnown OR Produced Identification
Type of Identification Type of Identification
Produced Produced
a ureLq
on a ,,tfln (Signature of Notary bli -State of Florida )
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� ;�G 14343 Myog9wilSSIONaft n` (Seal) ommission No. = = ,5VyJE LOVITT
EXPIRES Septem17,2021 MYO MISSION#GG143436
'?'ati,.• EXPIRES September 17,2021
REVIEWS , T G@ftJgG L0 1 ,•
SUPER ISOR PLANS ��G� j#CN'o td1�15$t�WN�L6G1 3pVd6� GROVE
fF�Y N# G1 �/�/ REVIEW R EXPI ESl;EWt&j*er17, 0218 VIEW
DATE +�oFr •.= EXP RES SePlem
RECEIVED
DATE
COMPLETED
Rev. 8/2/17