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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q Q
Date: Permit Number: 1 `®D - u3aq
SCANNED
BY
RECEIVED
St Lucie County
Building Permit Application AUG -16 ZN
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
PERMITTYPE:
Permitting Department
st. Lucie County
Residential
PROPOSED IMPROVEMENT LOCATION:
Address: IJ a l 6*& S`f'
Property Tax ID#:.3k)4 7 0- 0065— ocir)- % Lot No. /7
Site Plan Name: rY.Wisv Black No.
Project Name:
DETAILED DESCRIPTION OF WORK:
;TCjr-p4AnJ SWIMMIMOPODC. W
1`40- l w
CONSTRUCTION INFORMATION;
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ q3 Isizz Utilities: _Sewer _Septic
_ Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE: "
CONTRACTOR:
Name) I 0 A
Name:
-
Address: 154-2-I Some(,, nJN(S S--
City: P-Ppe-re P State: F`L
Zip Code: 3146T31 Fax:
Phone No. T 7a 6)76i ^ r 0 D $
Company: 0 el LOl-1 VaID15 TiJG
Address:5 Z *
City: r;f`C State:�-
Zip Code: 34MI Fax:
Phone No ?•7a SD) -9510
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail hUCIOD15 r 5"C�L1I GM*11' • dotn
State or County License OW-(c# 5 %(oLiii'
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIONLIEN LAW INFORMATION:''
DESIGNER/ENGINEER: Not Applicable
Name: M. QAND lI R0 CYS
MORTGAGE COMPANY: _ Nat Applicable
Name:
Addressh IIA81 1442eltodbod br
Address:
City: to C d Stater
City: State:
Zip: Phone 77al a01 - 104
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 Count makes no representation that is granting a permit Will aut orize the permit hold%f to build the subject structure
which is in conflict with any applicable Home Owners Association rules, by aws 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Contractor/License Holder
ig ature o ne a/Contractor as Agent for Owner
STATE OF COUNTY OF FLORIDA
S{ LLLGe
STATE OF FLORIDA �+ L uG
COUNTY OF
The forgoing instru' ent was acknowledged before me
this Z day of 1 20 I, by
The forgoing instruMent was acknowledged before me
this Z day of � 20n by
It) MUNVAT1
1nwdz VYl
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification ---
Produced L
Type of Identification
Produced
[[
(Si ature of No P lic-S pLr
(i nature of Notary Public -State o FI rida )
NOTARY PUBUC��
Commission No. pF pp
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Commission No.' ' NOTAfjYPIJ"ai),
. Con;!311GCa0.959
STATE PA
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