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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number: a•,
Ell k� C
CASE
4W V L� FEB-2 02020
BuildingPermit A lica i
pp Pplmitting Departmer
Planning and Development Services St. Lucie Count FL
Building and Code Regulation Division yi
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: "cam er1A QJ Orton '�kC,fa�e
Site Plan Name:
Project Name:_
Ll
Lot NO.
Block No.
IO-C:— YL e_
OSed S " d - NO VPh• e'bir i n a n9w,91/el.
Additional workto be performed under this permit -check all that apply:'
—Mechanical —Gas Tank —Gas Piping —Shutters
—Electric —Plumbing _Sprinklers —Generator
Tofa:iS-T t of Coest�uct�o ICI �kk Sq. Ft. of First Floor:
Pam00
C sTofrConstructi'dha, ��ID�• Utilities: wer _.._- —Se—Septic
—Windows/Doors
Roof Pitch
Building Height:
O NERN LESSEE;
GONTRACTOR•;
Name -ZD i i IQ t cob
Name: d�[l
Address: A 01 6¢sr, lam•
Company:
City: F� Q I'.e.fC2 I Stater
Zip Code:3N011,4U) Fax:
Phone No..3R ?� RD�S
Address:
',
City:1� C" -�' !esfJ lsS.r,O-Al :' .�,fState:
Zip Code;;._
Phone No —` -
E-Mail —. &-A4--LCS1EI( c(YA�, COa l
Fill in fee simple Title Holder on next page ( if different
„from:the Owner listed above)
E-Mail
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.
SUP P.121 E
NUENTANG O IS RUCTION I _
fJI
I 111111IM611i'l:
DESIGNE
/ENGINEER:
Not Applicable
MORTGAGE COMPANY: / Not Applicable
Name:
'(QCJ
s
1p,
Name: �
Address:
®
1 .. S
dnMs t
� d, )- 1 State:
City: � f gta e: &---��
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,AVORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Agtc�—�" ax��&
t' n "re7nf Owner//Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instru nt was acknowledged before me
The forgoing instrument was acknowledged before me
this :;it day of ,1h__. 20 OZQby
this _day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification '/
Personally Known OR Produced Identification
Type of Ide fop
Type of Identification
Produced -,
Produced
(Signature of Nota ublic- State of Florida
(Signature of Notary Public- State of Florida )
Commission No. Mr:""•.. AUDREYIj;PHREY
Commission No. (Seal)
cWMIISSI0NAG0900617
-�• S: M: March 6, 2023
,
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It
OR
REVIEWS
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2///19