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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dat Permit Number:a c)
9r RECEIVED
b �L U DEC 14 1010
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Building Permit Application Permitting Departmien.
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: ;U-. �,n r_ a✓hL 4)1�U�
Property Tax ID#: Lot No. dpt:y
Site Plan Name: /l dyertl A VIES &.ST4I,�-:S Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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s�, �ao�psi � � t� C,r2-1- 4_1(1W1e_k
&S
New EI ctrical 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: $ ���(f 10 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name /' ' ,f1 9 Name:
Address: � 22 �o�L�z�ovr� PIYCi- ) AP-t Company:
City: �� r,L� State: 1 Address: 690 lf/ k P f/ -;)2
Zip Code: ;)`f q' Fax: City: r, Stater
Phone No. Zip Code: �y�j S` Fax:
E-Mail: Phone No 7 2L,5 7 /--I 5 7 1
Fill in fee simple Title Holder on next page(if different E-Mail f_,AS5 'M A" Ce-)
from the Owner listed above) State or County License 36
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 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 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 reco r Notice of Co mencement.
ignature of wner/Lessee/ o ra as Agen for Owner ignatur of Contractor/L tense H er
STATE OF FLORIDA STATE OF FLOI�DA ��`\
COUNTY OF S�. Lac- \� COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pres nce or Online Notarization Physical Presence or Online Notarization
this day of t2 C 2020 by this LA-day of U4—c- 2020 by
SSA, 1 \ Y--,4,C y �""SS-,`� yg","-
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 L Produced L
n
(Signature of Notary lic-State of Florida ) (Si ature of Notary bli -
RIEc,1�ItN`' 4� !�P Y �_._ 1 GNENS
�"� °�`.; DEANN) MPR4 GG 022023
Commission No. �.a d +. , Seal) o Ssloy b�G6, 1 fission No. _ '�Uf�` 7 h9 COMMISSIQ5__,jfi p20
ti1Y s peckm Un wn _r. a1RES:D hers
,P• :*= EX?qRNNotanl+'Ubf,c '`+r. .�o?` ,oi��ThNNotary�bl'wUnderwr
REVIEWS FRONT SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER IT17VIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
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SURVEYORS NOTES: �1 x
I.UNLESS OTHERAISE NOTED ONLY PLATTED EASEViNTS ARE SHO)IN KREDIL r
2.ALL LOT DWEN90NS SHOWN ARE PER PLAT UIRESS OTHER SE SH th � ��
cu
a ko ukocacRouND UTILITIES OR iVPROYFNENTS IIIERE LOCATED UNLESS
OTHERWISE SHO11N.
4. THIS SITE LIES OTHIN FLOOD INSURANCE RATE VAP ZONE X VAPI E1
12111C0110 J DATED:2-16-I2, V'
5.FLOOD ZONE 5H*KRE04 IS AN NIERPRETAOON OY THE SURVEYOR 8522 LONESOME PINE TRAIL Cerluiea 10:Hob IS Erk Will and TIE Ronson ra
AND 15 PRoo�y�DED AS A EOURTESY. THE FLOOD ZONE SHOULD BE VERSED Atlantic Land Desi ns K fine Loons, LLC
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Br A oLTEHAEINATO AGENCY.. SCAtt;1°•�0 6 Kline Compons ron
6.BEARINGS SLOWN HEREON ARE BASED ON THE CENTER LINE OF of the a_.lTreosvre CDDeI, L .1, Chive silk InswonCO Co.
LONESOVE PINE TRAIL AS BEING 489.4 061 ACCORDING 10 X PLAT • 1 uArE:6-2B-18 F6r k+.... ee•cw a w.+en•,n•«,+I sreeU I w•,•e)cuuIV...
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DESCRIBED HEREON. $11�JC 21s JahsaDorese. •M I•be•ee••e(Iu•I•ee••mme^u Ie1en IN Inc It•Ie. +wi•1
1.U.O.L pD�(N�O1ES UTILITIES AND ORIuNAGC EASEIIENI,U.E.DENOTES PL 54 142s wl coe (772) Fl 34958 '•'r•1^rrI'Lh• Inlm,.,Ierne lcel sI e•ale,oI Cne•lu 6ry ,
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&THE ACCURACY OF THIS MAY 15 PREMISED 04 THE EXPECTED USE OF DATE: REYISIONS °M"^+'"'"c"°"• l-
THE SURVEY. THE EXPECTED USE/PURPOSE or MIS SURVEY IS IIDRICAGC
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FINANCINGS OR DELETIONS
FOOT T N 7.IS SU FEET�QAfiBETTER. Dw.+ou06n1UI91 e+e• .>
9.ADDITIONS OR OELIRONS TO Des SURVEY uAD BY ANYONE OTHER MAN NOT VAUO WIT'gVT TIN AUTHENTICATED ELECTRONIC --�
ME 9GNNC SURVEYOR IS PROHIBITED INMOUT'WRLITEN CCNSENI, LAST F I ELU DATE:6-27-16 IGNATURE ANUAUTNEN1IrATEO ELECTRONIC SEM I, •'