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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j �}
Dated � Permit Number: 1 ,5Vr-� �
RN X
1 Building Permit Application 'ggc,��at
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mobile home
PROPOSED IMPROVEMENT LOCATION:
Address: 4145 N US HWY 1, FT PIERCE
Legal Description: 2134 40 THAT PART OF S 730 FT OF SW 1/4 OF NW 1/4 LYG W OF US 1 (2.13 AC) (OR 3649-1987)
Property Tax ID #: 1420-141-0009-000-0 Lot No. 48
Site Plan Name: Block No.
Project Name: COUNTRY COVE MHP
Setbacks Front 10 Back: 15 Right Side: 15 Left Side: 15
DETAILED DESCRIPTION OF WORK:
NEW MOBILE HOME REPLACEMENT 2015
CONSTRUCTION INFORMATION:
AcIclitional work to je na orme under this permit — c. ec a apply:
Z✓ HVAC L_J Gas Tank ❑Gas Piping Shutters Windows/Doors
❑✓1 Electric ❑✓— Plumbing Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 2450.00 Utilities: 91 Sewer []Septic Building Height: 13
OWNER/LESSEE:
CONTRACTOR:
Name Country Cove MHP LLC
Name: DWIGHT DOUGLAS
Address: 49 SW Flagler Ave #201
Company: QUALITY MOBILE HOMES
City: - Stuart State: FL
Address: 4775 ELON CRIES
Zip Code: 34994 Fax:
City: LAKELAND State: FL
Phone No. 772-252-4399
Zip Code: 33810 Fax: 863-606-5099
E-Mail:
Phone No. 863-529-2370
Fill in fee simple Title Holder on next page ( if different
E-Mail: nancyarmstrong61@gmail.com
from the Owner listed above)
State or County License: IH1025264
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL'CONSTRUCTION
LIEN LAW
INFORMATION
„x
• ..
.
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: N/A
Name: N/A
Address:
Address:
City:
State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY: Not Applicable
Name: N/A
Name: N/A
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.
Signature of ner/ Ag nt/ LessdO Sign ture of Co actor/License Holder
STATE OF FLORIDA
COUNTY OF Pou,
STATE OF FLORIDA
COUNTY OF POLK
The f ing inst n was ac rnowled ed More me The f going instrument was acknowledged before me
this day of 20 _may this day of Main , 20_1g by
/S
DWIGHT DOUGLAS DWIGHT DOUGLAS
(Name of person acknowledgin (Name of person acknowled ing )
(Signat re of )ary Public- State of Florida) (Signs re of of ry Public- State of Florida )
Personally Known. x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced FLDL Type of Identification Produced FLDL
! , NANCY MIMS ArjYMONG •�a'," M
Commission � I Commission No. •.� NANCY g
MSTRONG
MY COMMISSION # FF197899 ; y �,� MY COM1AMIS3I ON # FF197899
APIRES Fetirue 10, 2019
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Revised 07TMZU14- —
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
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