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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. _ 41,22I2D;Z/ Permit Number: \� v
RECEIVED
l�o aC��DC APR 2 7 1021
P9rmitting Dtgg'rtment
Building Permit Application St. Lucie Count/
Planning and Development Services .
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION; : r.
Address:. 700 Vlil+ag,-e W6tq Po.H Sail7f- woe, FL 3 q4o
PropertyTaxlD#:
Site Plan Name: 9,0s-erye,
Project Name:
New Electrical Meter Second Electrical Meter
COWRLICTIOWI NFO:RMATION.
Lot NO. /.2
Block No. AM
Additional work to be performed under this permit -check all that apply:
—Mechanical. _ Gas Tank = Gas Piping _ Shutters Windows/Doors Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height: J
'OWNER/LESSEE. -`
CONTRACTOR:
Name -e
Name: Luis Quinones
Address: 7d&o d /Wrl ° O -etk
Compan .
City: at-t, aln> - L O e State:
Address: 865 S Kings Hwy h° rLu-
,
Zip Code: 3J.,I & Fax:
City: Fort Pierce State: FL
Phone No. �7a- �i��-.2..�2(p
Zip Code: 34945 Fax:
E-Mail:2kagrod La19J/"0A0/i6-f
Phone No 772-446-1139
Fill in fee simple Title Holder on next page (if different
E-Mail info@roofsbyrhino.com
from the Owner listed above)
State or County License 0 K - 3a &Ik
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
-SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
NEER: _ Not Ap
Name: N/A
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: N/A
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name: N/A
Address: .
.City:
_ Not Applicable
State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: N/A
Address:
City:
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.
Inconsideration 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. if you intend to obtain financing, consult
with lender or an attornev before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
� 4e
STATE OF FLORIDA LL
aCie
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
V
Swop to (or affirmed) and subscribed before me of
✓
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this 2lndday of x1DYi 1 , 2026 by
this 2 h2—�iayof Apil I 2020'by
Law duifinnes
WIS Qurnvn�e-p
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
Produc
Produ
l
(Si ure of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. Lary Pubii�4 of Floes
Commission No. N(if6"J'�biic state of Florida
Desiree Flaxen
e My Commission GG 24Q886
® Desiree Flexen
�a My Commission GG 24Q898
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Rev. 5/6/ZU