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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11-3-2020 Permit Number:
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° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
RECEIVED
NOV 0 3 2020
Permitting Department
St. Lucie County
Residential X
PERMIT APPLICATION FOR: ACCESSORY STRUCTURE
PROP6SED IMPROVEMENT LOCATION:
Address: 1708 OLD FFA RD
Property Tax ID #: 2303-232-0005-000-4 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED.DESOMPTION OF WORK:
SIMPLE OPEN ENDED 95 sq ft ACCESSORY STRUCTURE TO KEEP HORSE HAY DRY
m e 4 att
New Electrical Meter Second Electrical Meter
CONSTRUCTICIN;IN,FORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 95
Cost of Construction: $ 800
Sq. Ft. of First Floor:
-Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height: 7ft
OWNER/LESSEE: "
CONTRACTOR:
Name JOHN L. VAN HAREN
Name: SELF
Company:
Address: 1708 OLD FFA RD.
City: FORT PIERCE State: _
Zip Code: 34945 Fax:
Phone No. 772-999-4212
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
E-Mail: LTVHNSCC@COMCAST.NET
Fill in fee simple Title Holder on next page (if different
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 HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
u1
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: x Not Applicable
Name:W Ze. grcblG/,T"j 64lf
Addr ss:1'1ss•5 &.00 o &-k
City: 76 i-39AGt/ State: _7:-�
Zip:W2.1?46 Phone 72— 36a-141?9&
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
x Not Applicable
BONDING COMPANY: x Not Applicable
Name:
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 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 vour Notice of Commencement.
Y
Si na re of Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA ))
STATE OF FLORIDA
COUNTY OF /U�l'i1 C' -
COUNTY OF
Swor o (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Ph sical Presence or Online Notarization
Physical Presence or Online Notarization
this day of un), 2020 by
tiro -h -n A. Y)—° n
this day of , 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identif t' n
Type of Identification
_
Produced Y + L,
Produced
(Signature of Notary Publ
�d on REY B. HU PHRE
of Notary Public- State of Florida )
` = MY COMMISSION It GG 30081
lignature
Commission No.
:,� (SORES: March 6, 2023
mmission No. (Seal)
Vv�r Bonded Thru Notary Public Underwrit
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