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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 2 , 0- -
RECEIVED
o` Ji it , 1. MAY 0 4 2011
Building Permit Application PQrmittl.ng Department
Planning and Development Services St. Lucie Courrty
Building and Code Regulation Division Commercial I Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772j462-1579
PERMIT APPLICATION FOR: rNe�_ ay) Swvc� S1 l IPQ
PROPOSED IMPROVEMENT LOCATION: _
Address: ZD C V1 VI11,^XUY'N7 I( 1'Ur lyX;i
Property Tax ID # f 3 0 1 ' W 13 - C7 31 D ' 000 Lot No.
Site Plan Name: . Lakewood Park Block No. 115Z
Project Name;
DETAILED DESCRIPTION OF WORK:
NPwrnnctnrntinn SingilafamilyhnmP
Li 2
New Electrical Meter Second Electrical Meter
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CONSTRUCTION INFORMATION:.
Additional work to be performed under this permit— check all that apply:.
_Mechanical _ Gas Tank _ Gas Piping utters indows/Doors, _ Pond
lectric Plumbing Sprinklers YY Generator oof Pitch
Total Sq. Ft of Construction: _� -_� 3 Sq. Ft. of First Floor:. (12 50
Cost of Construction: Utilities; _Sewer Septic Building Height:
I
OWNER/LESSEE:_- - _
CONTRACTOR:.
Name. W IH.FLLI C
Name: Morevoeyle
Address: 3MIGovemors Lake DrSuite 200
Company: WJHRLLC
City: - State. GA
Address:_3mi Gavefors Lake Or Suite 200
Zip Code:. 30071 Fax; NA,
City: Normoss - State: GA
Phone No.. (321)--6629 _
I
Zip Code: 30071 Fax: NA
E-Mail:.Heather.Dahtin@CenturyCommunities.com
Phone No .(3r2nisn2e
E-Mail Hoathr3baht ntelCentuNCotmm ^uJos com
Fill in fee simple Title Holder on next page ( if different
State or County license CGC,51745e
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from the Owner listed above)
If value of construction is 25W or more, a RECORDED Notice of commencement is
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is requ
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name:. AtidW-MiKuln
Name:
Address: 300-Brookside-Ave
Address: .
City: ArnbW State: PA. _,
City: - State:..
Zip: _ tsoo2 Phone ijSjsai;�Aonn
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.Coufi makes no representation that is granting a permit wili authdNi - the permit holddi'to build the subjectstructure
which is: in conflict with a' pplicable,Home Owners Assaciation rules, bylaws or: and erml ants;that may restrict _or prohibit such
structure. Please consullwit your Home Owners.Assdciatibn and revieW yaurdeed for any reOrictlons:wliich 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.paying tuvice for
Improvements to your property. A Notree:of Commencement must be recorded in the public records of -St.
Lucre County -and posted on the jobslte before the first inspection If you intend to obtain financing; consult
with.lender or an,attorii-y before commencetiwork.or recording -your :our Notice of commencement:
Signatur _ � , wrier/ essee/Contractor'as Agent for Owner Rure_cf'C, : tractor/License Holder
ST ORI A F FL0RIDA
COUNTY OF _ E3 (_jft✓a_ /GI COUNTY OF
Swoto (or affirmed) and subscribed before me of Sw IFS to (or affirmed) and subscribed before me of
V Physic I Presence or Online Notarization Physical Presence or Online Notarization
this ay of _ ( I a11t/GL / -i/1_. 2021 by thi I Rday of _ 2021 by
Name of person
Personally Known )—OR Produced Identification
Type of Identification
Produced
of Notary Public- State
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f my Com^_e0A HM 02WiO
REVI
COUNTER I REVIEW I REVIEW
RECEIVED
DATE
My
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Name of person enf.
Personally Knownroduced Identification
Type of Identification
(Signature a 6FWft
error C DdAn
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PLANS
REVIEW I VREVIEWON C SEATURTREV EWLE I M EVIEWVE