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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: Permit Number: �o03
RECEIVED
Building Permit Application MAR 3 0 2020
Planning and Development Services
Building and Code Regulation Division T. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Lf
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION.
Address:_12S 0C) ffiQ-- i.-+ C4+- R 8
'
Property Tax ID#: `7�/ (� 333 063 Lot No.
Site Plan Name: Block No.
Project Name:
,DETAILED DESCRIPTION OF ON .0K
Ek G all e-7 0,? D Ei b �5i d67
CONSTRUCTIQN INFORMATION: ,
Additional work to be performed under this permit-check all that apply:
_Mec anical _Gas Tank _Gas Piping _Shutters _Windows/Doors
lectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
n. Cr-
Cost of Construction:$ Utilities: Sewer Septic Building Height:
•OWNER/,LESSEE CONTRACTOR:.
Name Gro C Vlh�Srr Name:
Address: �K-Dp 6-«S �+ 0'rr� Ri Company:
City: 'Po S UC-(e— Stater Address:
Zip Code: 5qq97 Fax: 77L//CIU City: State:
Phone No. 7 7 6 7 12z/D`7 Zip Code: Fax:
E-MailMo/G��� CP-rY-J ei�)1 90 . �e� Phone No
Fill in fee simp`le Title Holder on next page(if different E-Mail
from the Owner listed above) 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.
SUPPLEMENTAL CONSTRUCTfON LIN LAW INFORII/IATION
�. .,..
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forging instr ent wa acknowledged before me The forgoing instrument was acknowledged before me
this�(�3ay of (( 2000 by 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 Identification Type of Identification
Produced Produced
�Swtsof=M
(Signaeo tary - jQ�pc�a ) (Signature of Notary Public-State of Florida)
yp Expires 10/232022
CommIs Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.Z/ 9
T0: St. Lucie County Building Department
REF: Statement affidavit for signatures
Please accept this letter as permission for Joseph J. Short to sign for Gerard C. Hennis
any legal documents required by building department to obtain permits. Thank you
Gerard C. Hennis.
C
�,►►� Notary Public State of Florida ,
Kayla Short
+ My Commission GG 252217
�RdfP Expires 10/23/2022