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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11 IU IP q Permit Number: 7c,Od 6.dd�1
— — -1111111111110 Building Permit Applicat on MAY U 5 �ppp
Planning and Development Services
Building and Code Regulation Division ST• Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ✓
PERMITTYPE: 5 F V,
PROPOSED IMPROVEMENT LOCATION:
Address: Q 1A rn p C • . R je.Krk, V-L
Property Tax ID#: 3ti0a-Co7-03`42 —000-3 Lot No. 30
Site Plan Name: i N a ,JA vv r € Si ai e�(10,1 02 Block No. 6—
Project Name:
Additional work to be performed under this permit -check all that apply:
)(Mechanical _Gas Tank _Gas Piping _Shutters -XWindows/Doors
](Electric Plumbing _Sprinklers _Generator _A Roof Pitch
Total Sq. Ft of Construction: l t7Qg
Cost of Construction: $ i 190/ 00a
Sq. Ft. of First Floor:
Utilities: _Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
r:i<< H
Name S� 4u[7e l o-hra� �er uman: I �/'
;
Name �� 1 uu e 1 �n w�44-44- -�or 14tA an:ly
Addres�s•-�iOoL C%6t1 S�
Co_mppany rx_hr G% nnnr n7ani�V 7
City: r f. P2 rCe State:,
Zip Code: Cj 99-0 Fax:
Phone No. 772- Cj6y-Q7
Address: 7 O `d S rei+1 .5i
City: R Qi cr ce- Stater.
Zip Code: Stl9 -o Fax:
Phone No 7 79- f-16 y- 111-7
E-Mail: SoSdh is L+I(Aci e-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail SnSe Ph @ Si i u c C h 44 i a . new
State or County License
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.
SUPPLEMENTrAL CONSTRUCTION LIEN LAW INFORMATICJ
DESIGNER/ENGINEER:
Name:
Not Applicable
p :1�er:no
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: L1kgJ SV, L �:Q,
09Aa'l
Address:
City: E010nct,
Zip:?ggu6 Phone f7-pai
State: F:L
N04_1oe3
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signs• oT-O-finer/ Lessee/Contractor as Agent for Owner
Signature f Contractor/License Holder
STATE OF FLORID�)j�
I ec��J
STATE OF FLOF!Bt
OF �.LP{�Z
COUNTY OF ogf •
COUNTY
The oing instr as acknowledg efore me
I�
The f oing instrr menX as acknowledg efore me
by
this dayof 2020by
thisdayof.YTVYVV l .20_ i
'-"�'�.
Name of person makin statement.
Name of person making statement.
77
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type Ide ion
Type of Identification
Pro uc
""" TONYA R. MILLS
Vr•.aoa.,
u d TONYA R. MILL
?� Notary Public -State of FI
;Notary Public -State of Florida
Commission q GG 918
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76 y®•= Commission N GG 918
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(Sig Lure o ta/ryy Pnubliic-1 October 01, 2023
ature otary Public -
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Commission No.(X "I18a l�
(Seal)
Commission No.6C711000Q7`5 (Seal)
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