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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:(0- �n Permit N Imber:1��
RECEIVED
Building Permit ApplicationIFEB 0 61010
Planning and Development Services P aKment
Building and Code Regulation Division - permlttln9 Dep
2300 Virginia Avenue, Fort Pierce FL 34982
St. Lurie Countv
Phone: (772) 462-1553 Fax]]: (772) 4622-1578 Commercial J Residential
PERMIT TYPE: gui W iilQ - l C11C2
PROPOSED IMPROVEMEN OCATION:
Address:.20Q 5 Ki= RtOW For+ Pielce Florida 30"15
Property Tax ID #:
Site Plan Name: _
11
Lot No.
Block No.
I CONSTRUCTION INFORMATION: I I I
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
• 1 1
Total Sq. Ft of Construction: Sq"Ft. of First Floor:
CostofConstruction:$ ASS . Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: i
Name doves Travel Sfops/Connfry Sl&rs 2nc.
Name:' 786)wA (iye(y
Address: 15 (J �pfh Si• Sui4e 'mo
Company: g/AenSainllrl l CYeAe Fenrp
City:'•7o1se+ State: OA
Zp'Code:.`7ii//9 Fax:
PhoneNb.9i2• b08- 97(07
Address:A?.0 1%1d/fin RJ SE
City: Palm tiey I Stater
Zip Code: 3aGCF1 Fax:32)-31;?-i47$7
Phone No : i-i/ r5q
E-Maikaofeti&7Ployes.com
Fill in fee simple Title Holder an next page (if different
from the Owner listed above)
ft
E-Mail or o7p8Sl6'nd (QWe PAce& ddhnn. com
State or County License 30N $5
i
It value of construction is s2500 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.
i
4 �
I
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 io 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,r 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: YO R FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROY NTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTE E JO TTE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIT NDER RAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signa) Owner/ L ssee/Contractor as Agent for Owner
4Signature of Cont or/License olde
-
STATE OF FLO IDA
STATE OF FLORIDA
COUNTY OF; . lucid
COUNTY OF AT2U6lid
The forgoing instrument was acknowledged bef
The forgoing instrument was acknowledged befor
(�y this day of San 1u 2020 by q
this�dayof Mt1cHlu .2020 by
evin O
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Name of person making statement.
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Name of person making statement.
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Personally Known OR Produced Identi
atlon-
Personally Known X . OR Produced Identifi
ign o C
Type of Identification,
:a Vo.E -
Type of Identific ion
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Produced Fib D�iVL2S A,LL/PJG
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Produced I✓�
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(Signature of,l tary Public- State of Florida )
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:
(Signature o Notary Public- State of Florida) _
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Commission No. (Seal)
Commission No. _ 161737; (Sealt,,y
• r�
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19