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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLIC'ATIONIO BE ACCEPTED
Date: 'S Permit NumbLRE]
SCANNED
BY RECEIVED
Buil9181 LUde County
ing Permit ApplicationAY 0 8 2018
Planning and Development Services Building and Code Regulation Division ing Departm_ ent
2300 Virginia Avenue, Fort Pierce FL 34982 i e Co U r j
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial R tY, FL
PERMIT APPLICATION FOR: Building
PROPOSED IMPROVEMENT LOCATION:
Address: r180rl BELMoN%' 4f/EnIUE� Fob/EiQC� , FL S
Legal Description: Lakewood Park - Unit 4 - Blk 31 Lots 22 and 23 (Map 13/11 N) (Or 3933-218)
Property Tax ID #: 1301-604-0118-000-1 Lot No. 22 & 23
Site Plan Name: Block No. 31
Project Name:
Setbacks Front Back:. Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Install opened 24x16x10 detached accessory structure on footers/concrete
**NO ELECTRICITY**NO PLUMBING" ii
CONSTRUCTION INFORMATION:
Additional work o be performed under this permit — check a apply:
11HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator Roof 3/12 Roof pitch
Total Sq. Ft of Construction: 360 S . Ft. of First Flogr: 360
Cost of Construction: $ 2095.00 Utilities: Sewer Septic . Building Height: 10
OWN ER/LESSEE:
CONTRACTOR:
Name MELU! /4& /LL
Name: ORES PL.,gYE!Q
Address: ?B07 8EGA-10A17-,1VE1V0
Company: C_#kP097-S R-NYWHERE
City: FORT PIERCE State: F!-
Address: PO BOX W(A
Zip Code: 3-f 95-1 Fax:
Phone No. Lr%%2) 659 " 2069
City: (S .4P-XE State: F L-
Zip Code: 320g 1 Fax: C31L) fog ^/1 /3
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail: , I �DC�I?'! /�5 f -��� gnlay/. to
from the Owner listed above)
State or County License: CCA1126 9C115-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name:$ECfITOL �'AIC�/NE�/NE ��ST/�
Address: bQSW�S'TNEGU YoRX i9-!/�'itlUE
City: DELq�p State: FL
Zip: �'2.72U Phone ""
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
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 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
commencingwork or recordingour Notice of Commencement.
Rev. 8/2/17
Signat of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF gRq-D Fo RD
r oing instrumr�ent was acknowledged before me
The 140
this �� day of 20 /B by
The forgoing instrument was acknowledge before me
this � day of f� P1Q..�L-. , 20 /� by
yiIMES PL �yEl�
04MES IOLAyEk
Name of person making statement
Name of person making statement
Personally Known X_ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced -
Produced
////�► J �I
(Signature of Notary Public- State of Flori a .)
(Signature of Notary Public- State of Florida)
Com I�Y Notary Public State of Florida (5 I)
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r�o�°. Expires 08/25/2019
ad° Expires 08/2512019
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