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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f `�
Date: 3/11121 Permit Number:
91T. d U1E
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' Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential xx
PERMIT APPLICATION FOR: Concrete driveway extension
PROPOSED IMPROVEMENT LOCATION:
Address: 807 Brack Rd Fort Pierce 34982
Property Tax ID #: 3403-701-0031-000-4 Lot No.4/5
Site Plan Name: Block No. B
Project Name:
DETAILED DESCRIPTION OF WORK:
Extend concrete driveway to 24' wide
4" thick 3000psi with fiber mesh
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: 440
Cost of Construction: $ 7500.00
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name William Stewart
Name:Jose Vides
Address:807 Brack Rd
Company:JosB Concrete Perfection
City: Fort Pierce State: _
Address:383 SW North Shore Blvd
Zip Code: 34982 Fax: None
City: Port St Lucie State: FL
Phone No.7728125066
Zip Code: 34986 Fax: None
E-Mail: None
Phone No7728125066
Fill in fee simple Title Holder on next page ( if different
E-Mailjosbconcreteperfection@hotmail.com
from the owner listed above)
State or County License25230
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:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 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 attorney before commencing work or-gecording_your Notice of Commencement.
Signature of Owner/ L4 ss /Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of . 2020 by
so s �!
Name of person making statement. /
Personally Known OR Produced Identification l�
Type of Identification
Produced .�L
,tiPnYd�., ELLEN VAUGHI�
Comm st B-:State of Florida -Notary R�&k
°= Commission # GG 270079
My Commission Expires
)Q —4-4
Signature o Co tractor/License Holder
STATE OF RIDA
COUNTY OF S�
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this ( (day of 2020 by
Name of persnon making statement.
Personally Known OR Produced Identification
Type of Identification Produced pc�J{{��
Ce'--�
(Signature of Notary Public- State of Florida )
Comm s(q ' �- srsruELLENmrrtr VA of H Puble )
Commission # GG 270079
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