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All APPLICABLE INFO MUST BE.COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 12/03/2020 Permit Nrimber: V�L.-i3
Off.� RECEIVED
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® DEC 14 :1020
Building Permit Applicatipn Itting Department
Planning and Development Services St. Lucie County
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: Dale & Judy Schmidt g� o,,,,\
�PR.OPOSED IMPROVEMENT LOCATION:
Address: 13201 Harbour Ridge Blvd Palm City FL 34990
Property Tax ID #: 4425-604-0022-000/1 Lot No.
Site Plan Name: Harbour Ridge- Plat 5 Dewberry Village Unit 18 (MAP44/26S) (OR4049-693) Block No.
Project Name:
,;DETAILED DESCRIPTION OF WORK:
�5 n2.a..J' �t.�-eev. �o,A•. t�./ i �sv � � .--c�, � r- ��..s • - �_:
c l Gam/ a ti!M /� l!-"� T':ri7t. r`�• � /�9.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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: fO S `
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ACC
OWNER/LESSEE:
CONTRACTOR:
Name:' ,�
Name Dale E & Judy A Schmidt
Address:13201 Harbour.Ridge Blvd
Company:S'u�L.Q✓ti. Spreea.. S6L/i,)��+f
City: Palm City FIL : State: _
Address�:78JL.. SE g&y'46Y. Lv"
Zip Code: 34990 Fax:
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City: ; 6i�-• �c�tPi State:,
Phone No.630.853.3612
Zip Code�t(� Fax:—'
E-Mail:4327@hotmail.com
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail rArr..
State or County License T3 PA
from the Owner listed above),
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:
DESIGNS /EN IN
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:5101 1 ,,n\ror S
vi 41110
Address:
City: State:
City: State L
Zip:'?3Go 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.
1 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 j#toFnev before commencing work or recording vour Notice of Commencement.
as Agent for Owner
STATE OF FLORIDA
COUNTY OF '5. "CG
Signat=IqDA
ctor/License Holder
COUNTY
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COUNTY OF 5 Y
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orn to (or affirmed) and subscribed before me of.
Sworn to (or affirmed) and subscribed before me of
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Physical Presence or Online Notarization-
Physical Presence or Online Notarization
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his. 2—day of'�eCS , 2020 by
t day of Q C C 2020 by
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ame of person making statement.
Name of person making statement.
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Known OR Produced Identification
Identification
Personally Known OR Produced Identification
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Type of Identification
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Produced.
NO.�V ( DD INAMARIEGIVENS
IVIT'COMMISSION # GG 0221
EXPIRES: December 16, 20,
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