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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
PermitNumber:
Date: an SCANNED
BY
St. Lucie County
AUG 2 7 "M
Building Permit Application I ST. Lucie County, Permitting
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 X Residential
PERMITTYPE: SIGN
PROPOSED IMPROVEMENT LOCATION:
Address: 5090 NW DUNN RD FT PIERCE
Property'rax ID #: 3403.502.0194.000.3
Site Plan Name:
Project Name: TREASURE COAST HOSPICE THE LYNCH PAVILION
DETAILED DESCRIPTION OF WORK:
INSTALL 1 LOW PROFILE NON ILLUMINATED MONUMENT
Lot No.
Block No.
AT SOUTH ENTRANCE TO THE LYNCH PAVILION
I CONSTRUCTION INFORMATION: , I
Additional work to be performed under this permit— check all that apply:
—Mechanical — GasTank Gas Piping Shutters
— Electric — Plumbing — Sprinklers Generator
Total Sq. Ft of Construction: 6,750.00
Cost of Construction: $ E Vd 0'
Sq. Ft. of First Floor:
—Windows/Doors
Roof Pitch
Utilities: —Sevver —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name HOSPICE FOUNDATION MARTIN/ST LUCIE
Name: ROBERT GRALAK
Address: 1201 SE INDIAN ST
Company: FLAMINGO SIGNS LLC
Address:4444 SE COMMERCE AVE
City: STUART State:
Zip Code: :�4997 -22 0.7768
Fa
Phone N0.403.4402
City: STUART State: FL
2ip Code:.34997. Fax:
Phone N0220.7377
E-Mail: mmurphy@treasurehealth.org
Fill in fee simple Title Holder on next paie (if different
from the Owner listed above)
E-Mail flamingosigns@aol.com
State or County License ES12001146
It 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 ls*req'uired.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGA E COMPANY: Not Applicable
Name: JmEsPArr Name:
Address: 12201 SE COLBY AVE Address:
City: HOBE SOUND State: FL City: State:
Zip: 33455 Phone263-2frF7 - Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Address:
City:
Zip: Phone:
—NotApplicable
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 priorto the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or ang 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.
I
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
PQSTED-OWTHE-J�ITE BEFORE TFIE FIRST INSPECTI! TO OBTAIN FINANCING, CONSULT
,�*117114 YOUR LENDER OR A"TIrORNEY BEFORE REC ING YOUR NOTICE OF ENCEMENT."
Slgnatui?L'�L�ess_ffactor as Agent for wrier
signatdlre�G�ractor �Li6lder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYCIF IN " -r 1,y,
COUNTYOF W /I /I -C 1.1f
The for Ing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Irday of A cc'-14S7 261A by
this _5f_ day of /9 14 6 U Jrl 20J f by
a 0 4ILFIL 7 b-11 It t /.v K
4 1) 13 'r 'q T 1--k J
Name of person making statement.
Name of person making statement.
Personally Known Ll� OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi
17,tion, L 's- c�,sc
Type of ldenfficatlo� Z-/ C r'V
A IS'
Produced
Produced
Z4'f�r
/
(Signature of Notary Public- St
of Notary Pu i
Notary Public State of Florid
Commission No. M10 "JSftbert M Rice
Inature
Note,
Co m 0 Y Ublic I State of Florida
ission No. Roberl
Myc 010
W
t�!J, My Commission GG 07277E
"OF* Expires 04103/2021
'a, GG 072776
F'o
OF EX01reS 04103/2021
REVIEWS
FRONT ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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