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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
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 Residential
PERMIT TYPE:y\1I- rldms I r)OOr \s QCe,�Yi ef)-t—
PROPOSED IMPROVEMENT LOCATION:
Address: CL. , E,+ St Lucifl, FL_ 3L S2
PropertyTax ID #: EL425-• 703- 0120-D0- 1 Lot No. 36
Site Plan Name: Block No.
Project Name: Sa.,'►'ll dc,
DETAILED DESCRIPTION OF WORK:
�.�
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _V Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 2.3i ':S_�I • %O
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name (5y)n so-miao'-
Name:
Address: 0,512 M O-1-11berc:sjC--•
Company: T�1P iiom�'7eDc
City: Port- fit. L. )ciE State: PL
Zip Code: 3U9_S2_ Fax:
Phone No. 71L $13- 7229
Address: R-,&(2.S PLL, P-6.
City: A -I State: CsA-
Zip Code: 330(961 Fax:
No 7EL4- 22Y - 261 U
E-Mail: 7-7,?Vg01, 2&role
�(Phone
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail roh&-I0S&'r7r,+b(AQe CP-di es„ r• Corn
State or County License C G I �2�717
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:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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
WMU Vn"D 1 CNnCD nD AN ATTnRNEY BEFORE RFCnRD1Nr, YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLOC DA
COUNTY OF >�' L—VG P�
STATE OF FLORIDA
COUNTY OF t - I[_0 G
The forgoing instru,�entlwas acknowledged before me
Al 'y by
The forgoing instrument was acknowledged before me
this -I/ day of 20 1- by
thisday of �Zy / 20
�cdo,,l
Name of person making statement.
Name of person making statement.
Personally Known --- OR Produced Identification
Personally Known ,"� OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signal ure of Notary Public- State of � Y � aron Hallich
NOTARY PUBLIC
--�/�— Aaron Hallich
(Signature of Notary Public- State of,@, rc�RrJ
NOTARY PUBLIC
Commission No. ��f �) � ', STATE OF FLORI
/�,. I1
commission Noes l/7/.3%L ATE OF FLORID
o
Comm# GG95157
\._i- Comm# GG951577
J/r9�
jfr s>� o
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19
k01705GI — RG— Sc'-nGh�z
JOSE PH E . SMITH, CLERK OF THE CIRCUIT COURT — SAINT LUC IE COUNTY
FILE # 4714858 OR BOOK 4428 PAGE 1399, Recorded 06/04/2020 08:52:28 AM
PERt M NtJmm;
'J**QMbdrfic
.
CLrr
NQME QE 1
-no urtd4er�ipw tweby gives notlae #het imprv�►ernec� t vAll ber-2
kw. %
to CwUln reef property, and In acWrdanoe w lh Chapter 713,
Florida sues, f011trina inaat is provided 1n #GIs
.
of C�antt�er .
I[") TAX FOLIO No.: 3425-703- - 4-9
1. AF:SCfttrnON OF PWMTV.(I.�I des�x{p80ct Of tt* propertyet
edd�SS, if a
Savanna Club 2WLWDT
LOT 36 �r-�----
svaofmw�I - ,
Club Plat Three Blk 23 Lot 36 (OR 40988) 8512 Marlberry Ct., Port St. Lucie
Savanna
3. GENERAL DEWRIPTION OF IMPROVEMWndows
3, OWM INF(> 1WATION OR l IrSSEE INFOR1iIlAIICM IF'
E CoWTRAC M FOR TM tWROVEMEW:
Port St. Lucie, FL 3495 2
s umat arras :ohn Samida 8512 Marlberry t.)
Owner
-
�. Nama a+d eddras o� tea sts�Ia �llehotdar (If dK('aani t�vcn Owner Ilsted
�)�
THE HOME DEP
.
R. S. COWTR/MDRPS NAME:
6W Ault 121h Ave #1 iOt FL feud
, FL 333M � Ptr� n+�nbec: 754-2.24-2014
Clot s addra3x
5• StiItETY f I� a�pibable. a r�o�r of tea pe'�rnicrt fond !s t:�d�c4:
l /A
;. Num and ebdrs
b, Phom rx orft-.
C. At�ovrt of bOcx
NIA
6. 9. LENDERPS NAME:
leader`s add=:
_b. Phw a member~
7. Pwwm YAW the state of Fla4da dmigna d by Owwulxn
yh n WIces or other documents maybe served as pw1ded by
Seotlon 713.13 (i) (a) 7.1 FWds Stehltes:
a. ttstttia and t0d•eafi
b. Pbom nwrA l of daslged POW
8. a. in.addhion to hinml[ or herself, Omer des"tes
of
to rew1w a copy of the Lienor's NoUce as pmvided In Set lw
713.13 (1) (b), Flarida Statutes.
b. Ptro�m number of pawn a "ty deslq Wd by OWW.
9. Explmtton date of notice of commencement (the expiratTCO
may not be before the mnpleti on of oonshntion and fi rat
pvpmt to the omb� actor, but wilt be 1 year front the date
.AfA-MLt1KV1 to n��MCM& AktV nwkitt►rM 1ier*r aru v •eArTro
it unless a different date is speclf#ed);�..�_ , 20_____r_.
Tur rvbinA* r rW nC VUC Ktn-rt^r r.f- ,..... &.. —. —
tJ c of ,1 deol that I haveol�Ity
7-.t
edge ar�.
� 0e. 7
of O*mr O , or Ow>e�s or Ness's
Of r
t e of FLORIDA
nty a St. Lucie
The fteOn } ln*urwft wis edmw4edged be om me 1his 2'
by ohn Samida
for Self w of )
Pwtatally Kro m or # X 1
Nowy
pw lim•11(AR+om"
natice of commmcenmt and that the facts stated ihecein are litre to
—� 0 VL k l 1M
01T� Nam and Prn4lde Signatnq':
y t
...�. �► �..-A.Tr�j X10111i10_ _rat 1hul�tl 2020
OWNER
� 4 •
��•,` 1, ....,.aor ,♦�.
lot fact .
(,ow
y w
ob
of IdMUtl 4c>n
,
FL DL
fit%
i t, , or S
C�mrnl s$Ic
a o� mvwy puDltc)
Pagel
k HkMO Improven**M Agreementli
License #18 For 11
. ... ..... .
EC-G001440, CGC15-14813, CR .6-8.8 C.IQ13-767
.. CFC11:426'*t21, CK14"1116442, 22'640, CAC 1j818;8-31., CCCV1131713
CCC13311300
[ a: -------------
Me..s Srn-eldley
alerson Na. Me:*-
Rogtsftation No. (it app-11cable.)#
Horne Depot U4S,A.r, Inc. DeWo) of Mce
Se �
Proffer natned below Will fUrtllSh, onstatl andY
or service the equ:'Ipment lisled beiowi- al the price., iorms and co
nditions as oufl*ned on th s form,
:
Customer Last Name Cuslomer First Na" S10fe 'Branch Name Cwstomer : Lead/ P0#
Customer Address city State zip
WIN
18) al 3 7 2? 89,
Home Phone# Work Phone# Cell Pthone# customer -Ema-4 Address
NOTICE OR Of. RIGHT. TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WtTHOUT PENALTY i08*:UG_* TtO,,-N*'*
BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT,,
to 110 3309
650-0 NW 17J.h. Ave. Sw
- --------- - 3
Addtess city state, zip
tow;
Or Ems.11. Fusto
Service Provider Email -Addrm
BY NItDNtGHT ON THE THIRD SUSIMESS DAY A R SIGNING. UNLESS THE STATE
SUP PLE' :10'ENT PROViDES A DIFFERENT CANCELLATJONI PERIOD. THE STATE SUPPLEMENT
CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRISED BY LAW IN YOUR STATE.
YOUR PAYMENT(S.) WILL BE RETURNED W"IN TEN (10) BUSINESS DAYS AFTER HOME
DE.PorS RECEIPtOF YOUR NOTICE YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME
DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE
SAME CONDITION AS WHEN DEUVEREDo ANY MERCHANDISE OR MATERIALS DELIVERE0
TO YOU, OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN
SHIPMENT AT HOME DEPorS EXPENSE.
THE LAW REQUIRES. THAT
TO CANCEL PLEAS* SIGN
AINID WRITTEN NOTIC1 OF
Acknowledged by:
-on
ule
different payment
Contract Pr"'. $ 23881
Sales Tax $
HOME DEPOT GrVE YOU A NOTICE EXPLAINING YOUR RIGHT
:)W TO ACKNOWLEDGE THAT YOU KAVE BEEN GWEN ORAL
t RIGKT TO CANCEL
Signature
Date
, 1_0_tW_dv* * Payment. of ft CoMact Price is due upon signing unless a
requi . red by law, specified be4ow or in a Payment addendum.
tndudes all apoicabie taxes. Excludes finance charges,*
(If appficabe)
*Maxi_ M. lum 4%vasft ONL Yapp-licabie Jn MD, V alance 11791.0.75
j % Deposd.Arnount Rni
-emainQ B
Dep,
fto Now Doom - 840 pom PWWV WW. xws� 04, AMMO& Geovs xM0 - cA 14M 114MG-4464W
00"Wrame 04ft g
Amon wc* cwsow 04PW0*401 aWA0. 1*