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Date: I Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
23W Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof 0
PROPOSED.IMPROVEIIIIENT LOCATION
Address: 10725 S Ocean Dr.Unit 519 Jensen Beach,FL 34957
Legal Description: HOLIDAY OUT AT ST LUCIE-SEC B BLK N LOT 12 AND EQUAL PRO-RATA INTEREST IN COMMON
ELEMENTS(OR 323.130)
Property Tax ID#: 4511-502-0051-000-4 Lot No,12
Site Plan Name: HOLIDAY OUT Block No.N
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA1tEUf.DESCR1"6N flF'WORK:
Remove existing shingle roof and install5V mill finish metal roof.
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CONSMU TION 1NFORNOOht:::: :..> : .: ...
Additional work toorme under is permit—c ec a y:
app
HVAC E]Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq.Ft of Construction: 812 S .Ft.of First Floor: 735
Cost of Construction:$4,275.00 Utilities:T]Sewer OSeptic Building Height:
: .CONTRACTOR:`. :.
Name Mary K Blair Name: Ronald Latta
Address:2732 Meadow Park Dr. Company:Treasure Coast Concepts Inc.
City: Dayton State: OH Address: 3458 SW Pluto ST
Zip Code: 45440 Fax: may- Port Saint Lucie, State:FL
Phone No.937-760-1617 Zip Code:34953 Fax: 772-905-4910
E-Mail: Phone No. 772-777-8130
Fill in fee simple Title Holder on next page(if different E-Mail:tcconcepts@aol.com
from the Owner listed above) State or County License: MCI 330362
0value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL IN STRUCTIO.N E,N LAW hN�FOR! TI®_N:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 County makes no representation that is granting a permit will authorize thepermit 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 wor r recordingyour Notice of Commencement.
Signat a Own Lessee/Con actor as Agent for Owner Si na a o=ORIDA r/Lice Ider
STATE OF FLORIDA STATE/ COUNTY OF �_
COUNTY OF l
The for oing instru t was knowledg d before me The�fo gfoing instru ent was acknowledged before me
this day of 20_Kiy this 1\day of O 20�y
(Name erson acknowledging) (Nam of person acknowled ing)
(Signature of Notary Pu4' -State of Florida) (Signature of Nota y ublic-State of Florida)
ersgn tR Produced Identification Pers, ly Known Ofd Produced Identification
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Cof111�1�f;91Dn�Rd Expires Ma 2019 (Seal) C P. nan/!r- //uFF ea 1)
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Plat aY 27
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIONS � AAfir LE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW 12��/IE REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014