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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 71Zb
Permit Number rlJ�-1 —
F,707,a i,M E`�a � ``°7
FEB -2 5 2020
_Building Permit Appication
Planningand Development Services
P l��i Cf�l'CEII`Ig L,f�' 7cs �i?`!c".11,t
Building and Code Regulation Division St-.-Lucie County f FL
2300 Virginia Avenue,Fort-Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial � Residential
PERMIT TYPE:
PR'OPOSED,I MPROVEM ENT,LOCATION:
Address: S (� �^� I Lwc,J {�I
Property Tax ID#: JH JCI - 763 - OU(31 .( - O oG - Lot No.
Site Plan Name: `Block No. '
Project Name:
DETAILED-DESCMPTION',OF WORK
Me I int- r s (`uJ1+ Ung com�� jr- e { �` . J-&A W,
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters - _Windows/Doors
Electric Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ .100 d o Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: ' ` CONTRACTOR:
Name (j L) (CyAF1Y (-(oldin!�S- LLC Name: Cr�'G L.C¢o ea v-
Address: Company: yeilr'P1�Jt-
City: U.pf.0: �e✓4(-�� State: Address: 3 SO " : 'n e
Zip.,Code: �!Z� 'v Fax: City: F-U' r^ Qi?J`:LC State: FL--
Phone No: Q S 3 3'6'' �� 1 Zip Code: 4-q 4, Fax: ''f'/Z- Cl
• .
E-Mail: Phone No 7 __(f
Fill in fee simple Title Holder on next page(if different E-Mail 'l"j' 1`2Ad+2- rAC!E 0.01 ,(dM
from the Owner listed above) State or County License 1 v a Ss 17
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 CONSTRUCTION LIEN LAW INFORMATION:
pp MORTGAGE COMPANY: _Not Applicable
DESIGNER/ENGINEER: _Not A licable
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 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 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."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S!-L���'� COUNTY OF
The forgoing instruMen�was acknowledged before me The forgoing instrument was acknowledged before me
this_5-dayof �-C 1tidr 20 Z-0 by this Zr day of ('`� ✓✓✓ 20 20 by.
Crt� /..��cs:�r�►-� (ter.� 1..�;�r��.�
Name of person making statement. Name of person making statement.
Personally Known V OR Produced Identification Personally Known J/OR Produced Identification
Type of Identification Type of Identification
Produced Produced
CA4-r :A " uq'
(Signature of Notary Public-St a ture of Notary Pub['
�N'r� Notary Public State.of Flo ida r
G G l 6 ns L Woolley I p Notary Public State of Florida
Commission No. S V a Commission GG 1856 5COm ission No.G 6 Chr1s(S6V¢plley
My Commission GG 185665
NOF� w Expires 02/26/2022 Oa p Expires.02/26/2022
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19