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��AjjPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEIJ
�
�a e�" /• SCANNED Permit Number: /7I2 • D �63 )0<
BY
St. Lucie County RE0EEVED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:'
— iITL T1
I- 4o
Building Permit Application DEC 0 2017
Commercial &_/� Residential
N:'
(1( IaWa /17Q/1 Qi�I
�' -60r61 �/eri�. rya iZY
Property Tax ID a: 1 S Apr °l3—ono-9.
Site Plan Name: L I h dvneck Y C1 eb' 4
Project Name: .4 1a l: f hN'9>) �L i #J g n p1
Setbacks Front Back:, 'Right Side:
Left Side:
1 V2 t:
Lot No. I p -C
Block No. SAA
CONSTRUCTION INFORINIATION
4dditional work to be performed under this
permit — Efieck all
tat apply:
_Mechanical _ Gas Tank
_ Gas Piping
_ Shutters
_ Windows/Doors
_ Electric _ Plumbing
_ Sprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft of Construction: Iso
Sq.
Ft. of First Floor:
Cost of Construction: $ '� �T�
OO.po-
Utilities::;,•r_Sewer; •v_..'Septic -
Building Height:
OWNER/LESSEE: 7
CONTRACTOR: °
Name ; r C -. (
Name:
Address: 32.d,9' cS'_ GAtae✓yaw
C,1_1*10J
Company: Z'ono cllm&
City:, a 7 1iRGG '1
Zip Code: Fax:
Phone No. %7a !p7I— <p.Z 7
State: j L
Address: L6.92V W5
g3 h
City: a h
Zip Code: :3,0/2
Phone No
State:
Fax- 3OJ
E-Mail: Map
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Qo 't fO 9(j)n •felnel
Alvb K011 Q?e
State or County License
C (0{a' O
!J�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEIVIENTALCONSTRUCT-ION LIEN LAW,INFOAMATIO
� �'
DESIGNER/ENGINEER:
Name: MM E (
l�
_ Not Applicable
i1�
MORTGAGE COMPANY: of Applicable
Name: /,-
Addre d W�
/�l
Address:
City: 0
Zip: Phone
vjL
State:
Or 2 - 3l Y
City: —fin State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY: kjj4ot Applicable
Name:
Address:
Address: _
City:
City:
Zip: Phone:
Zip: hone:
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
commencing work or re r- our Notice of Commencement.
Zf
Signature f Owner/ Lessee/Contractor as Agent ner_
=Sig a ure o / act . /License Holder '
STATE OF FLORIDA
S-b Cif
STATE OF FLORIDA
COUNTY OF C!e
COUNTY OF M/A �/!gRr
The for oing instr men wledged before me
The forgoing instrylnent wa acknowledgedbeefore me
this daysI of 20��-by
this day of 20
QQ
o,J th 21t 1� o it n
""126e
Name of person making stateme&
Name of per66n makft statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
GLENNROR1,1Af1
^ * * MY COMMISSION# FF =69
EXPIRES:OcIobe.r1,2019
J —
✓
(Sie�attfre of Notary Public- State 6frioricla)
(Signature 6otary Pt{bJiy-State of Florida
Commission No. Seal
(Seal)
+°:.... l GLENNttc r6N
Commission No. MYCOML05SIOIyF,y1169
66ee Y2b ..5 , .. ,..I'll °., IjES:Octa r , 19
' ..... -BaMeE DMR dgim lar'siavka
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA'TURTL�'.`,
WANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW,-
REVIEW';- ,
_. REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev, 6/2/ 1 i