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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Li' o Permit Number: \C6' °H -- On*
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COUNTY RFO
E L. O R I D A - FJVP®
Building Permit Application 40,91 C
Planning and Development Services p 970,8
Building and Code Regulation Division es NK'!ng o
2300 Virginia Avenue,Fort Pierce FL 34982 t.Lucie cotiont
Phone: (772)462-1553 Fax: (772)462-1578 Commercial x . Residential _ g _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 879 NE Prima Vista BLVD
Legal Description: RIVER PARK-UNIT 3-THAT PART OF TRACT D MPDAF: FROM SE COR TRACT
D RUN S 62 DEG 22 MIN W 307.82 FT, TH RUN ON ARC
Property Tax ID#: 3419-515-0001-010-6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:.,
FPL Asked for a meter inspection i-t,. -)' '1" A"' K- -.
q ,
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit—check all-tar apply:
HVAC 11 Gas Tank Das Piping _Shutters Q Windows/Doors
ElElectric El Plumbing Sprinklers El Generator El Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction: SDS ,co Utilities:�Sewer LjSe
tic Building Height:
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OWNER/LESSEE: CONTRACTOR:
Name St Lucie Realty GroupName: Michael Leslie I
Address: Company:Mariner Dr. Company: M.L. Electrical MD. LLC
•City:
Jupiter State: Address: 11675 SW Rowena st
Zip Code: 33477 Fax: City: Port St Lucie State:I-L
Phone No.954-646-6390 Zip Code: 34987 Fax:
E-Mail:calmike009L aol.comPhone No. 772-0215-7298
Fill in fee simple Title Holder on next page(if different E-Mail: electricalmdllc@gmaIl.COm
from the Owner listed above) State or County License: 29529
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: [I
Zip: Phone Zip: Phone: rI
_
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 indicted.
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
commencin work or r- e din: your Notice of Commencement.
}:n. " --of Owner/Lessee/Contractor as Agent for Owner��:/---,/<
�3' , u of Contractor/Li:-1 - -.'der
STATE OF FLORIDASTATE OF FLORI[
COUNTY OF S •LAA-CA-A-- COUNTY OF k C.t„-2—e212.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 4L day of {7vwt ,20 (c(by this (7day of /i) v t I ,204-by
f"�• 1 -€-)l p. L-t.s I,e- ' ( LG-eA 0 L-E.s 1 k--)
Name of person making statementName of person making statement J
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Personally Known OR Produced Identification_lPersonally Known OR Produced Identification
Type of Identification Type of Identification 4 / ,
Produced 4:%1.. I 0 Produced lf��
of NotaryP blic-State 'rr s t (Signature of Nota ublic-State of El�g a:�"--'=i
(Signature . 3-r �rF NAMA�• qG 0 2021 ,r `--:-- ------
AMpRtEGlvtN2,n2'• I
Commission N\ __E :-,g � p,ICOMU"`"�Se 1.16,2026 Commission Nir-V-;°` ?� mvassol(S&' 1n20
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA-TM SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW • REVIEW
DATE
RECEIVED
DATE I
COMPLETED '
Rev.8/2/17