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All AppUCAVU INFO MU A BE CO MPLETED FOR APPUCATION TO BE ACCEPTED
tele; Permit Number:
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a
Building Permit Application
ildill''►p and Code upat DM'ska
2300 Virgift A venue, FoR Pie-rct FL 3r98I
P��: (772j 4624553 Fax: (772) 4624578
Commercial
Residential =0000
PER 0 -
MIT APPLICATION FOR, 1114� 111111��� q
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e t i F
t .It r fi
Q....n..YVIUSED IMPRO� FMFNT LOCATION,bT
5 , a '+`
11111�
Addressio
ProPerN Tax ID tt• �� � ' ��� ' � � �- � ' l7
Site Plan Name: khEWOOO
Project Name: �A� ITV N�mE �MPE�OI}�NIE±1T OF PtMER) ILA
DETAILED DESCRIPTION OF WORK:
ftftftMftft._
RE A(ww*C N\
EN
r
•
New Electr*cal Meter
Second Electrical Meter
CONSTRUCTION INFORMATION
Additional work to be performed
_Mechanical
`Electric
Total Sq, Ft of Constru
di
r
t
Windows/Doors
Lot No,.- Z�-
elak No. - M
�3
Pond
......_..o — r � ROOF Plum
coon: 00005�
under this permit - check all that apply:
Gas Tank _Gas Piping _Shutters
PI"mhiniff Sorinklers Generato
host of construction-,* $ ),q Ffy)O
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height
OWNER/LESSEE,r..
r r '
+ i r + ' * • }
N 7 .
Name�7R
Address:
Oty:
State.
zip rode: 3 I'R S 1 Fax: NIA
Phone No.
Eq- M a i I:
Fill in fee simple Title Holder on next page ( if diffe ent
CONTRACTOR:
Name: _�kA
Company:�1J
Address: 6,
City:
Zip (
g Cc Ufflk Jq S Avg
des. t4 1 Fax,
Phone No
U
State. -EL
E-Mail-?m��N6 PE�,m�TS Zq �J�mA��. com
from the Owner listed above) I State or County License Cf3c 0o
ff value of construction Is 25M or more, a RECORDED Noti a of Commencement is required,
If value of HAVC Is $7.,SW or more, a RECORDED Natke of mmencement is required.
d1% fT
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIONI
DESIGNER/ENGIN--- "-• ""n6"tiro unRTGAGE COMPANY:
Name:4
Address:
city&
a
ZiP6
LLKO � nv� nMy�,..o.....
Phone
FEE SIMPLE InU HOLDER
Names•
Addi
City:
Zip:
Phone:
State:
10
_Not Applicable
Namea..
Address:
City :
Zip:
Phone
BONDING COMPANY:
Name:
Add
City,
Zip:
OWNER/ CONTRACTOR AFFIDVR: Appliadon it hereby made to
� artily that no work or Installatlon has commenced prior to the Imance of a permit.
St. facie County makes no representation that isgrantinga rtnit will authorize thepertnit hdder to build the wbject struct��whichis in conflict with an applicable Home OwAssociation rules, bylaws of and covenants that may !estrict or prohibit w�
structure. Please consult wYith your Home Owners Assoclation and review your deed for any restrictions which may aPpIY•
In consideration of the granting of this requested permit I do hereby agree that I will, in a0 respects, pwaWform the �
in accordance with the approved plans, the Florida Building Codes and St Lade County Amendments.
The following building permit applications are exempt from undergoing a full wnarrency reviews room�d��0^�
aaessory structures, swimming pools, fences, walls, signs, screen roor"s and accessory uses to another nonpresideMW uu
WARNING TO OWNER: Your failure to Record a Notice of Commencement may rewk in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
Now
_with lender or an awn"_before commencing work or recording yo0 In �d� Nn0 % 1
f Commencement.
�fdt
Not Applicable
State8
: —
Not Applicable
Signature of Owjk�W - -1_ ned LesseelCa traciQr as Agent for Owner
STATE OF FL
COUNTY OF
Sworn to or affrmedj and subscribed before me of
tis
PhysPresence or Online Notarization
,� day of 2020 by
("I Ll KI,
WRNMNEEM�� - - -'Name of person ma ing- - staternerrt.
Personally Known
t�a�dlt�en����;4r��
Type of Identifitation 40
v,V,ana ��,iela
� r,ommiss+an GG 29�5
Produced ;7 � � a •1� • s 0210312073 �
(Signature of Notary PubljC- Stake of Florida J
Commission No., (Seal)
REVIEWS
1107; A i 4
RECEIVED
DATE
COMPLETED
ev.-5767Zt1—
FRONT
COUNTER
ZONING
REVIEW
Signature of
STATE OF FL
COUNTY OF_
Me-,Iiu.-
icense Holder
Sworn to (or affirmed) and subscribed before me of
M] . Physical Presence or� Online Notarisation
this A It day of pec , 2020 by
Name of person making tement.
P sonally Known 0
Ty ftlravo n
Produced
I d e n tifi ca ti o n - 00000000�
NOtary PublicState of F lord
iina into
My Commission GG 297640
%CV Expires OZO,112023
(Signature of Notary Publk- State of Florida
Commission No. (Seal)
SUPERVISOR I PLANS
REVIEW REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW