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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ::�I C)sb5r9
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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 4912 Amy Lane Ft Pierce, FL 34946
Residential x
Property Tax ID#: 1430-701-0009-9p(3 Lot No.
Site Plan Name: Green Acres unit 2 Block No.
Project Name: Gary/Sherry Drake shed
DETAILED DESCRIPTION OF WORK:
Install premade 10x10 shed
I
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: 100
Cost of Construction: $ 1500
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
CONTRACTOR:
-OWNER/LESSEE:
Name Gary/Sherry Drake co -owners
Name: Gary/Sherry Drake owner/builder
Address:4912 Amy Lane
Company:
City: Ft Pierce, FL State: _
Address:4912 Amy Lane
Zip Code: 34946 Fax:
City: Ft Pierce State: FL
Phone No.561 373 7234
Zip Code: 34946 Fax:
E-Mail:9duckd@gmail.com
Phone No561 373 7234
Fill in fee simple Title Holder on next page (if different
E-Mailgduckd@gmail.com
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.
SUPPLEMENTAL- CONSTRUCTION LIEN'LAW INEORMATION:.
DESIGNER/ENGINEER: x Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: = Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
Address:
BONDING COMPANY: x Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
i
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 an posted o �e jobsite before the first inspection. If you intend to obtain financing, consult
with lender o tt ev ore commencine work-cw-recordine vour Notice of Commencement.
Signat r o her/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA S%
t
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presene or Online N tarization
Physical Presence or Online Notarization
this (( day of 20 by
this day of . 2020 by
Name of person rrMking statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati
Type of Identification
Produced
Produced
ry`tPu P� �
(Signature of No - E LLEN VA U G H
�tate
(Signature of Notary Public- State of Florida )
*° N
of FloY9otarY Public
Commission No.
A; mission
Commission No. (Seal)
= G 27
pir s9
MY ComExpires
mission Ex ire
REVIEWS
FRONT
ZONING
S OR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/Zu