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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: L I Da • 0170
91ro
_ O ,
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residentia
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:ROOM ADDITION
;PROPOSED IMPOVEMENT1LOCATION
Address: 5512 PINETREE DR FT PIERCE FL 34982
Property Tax ID #: 3402 602 0283 000 8. Lot No.16 and 17
Site Plan Name: PINETREE PORCH Block No. 8
Project Name: front porch
WE ARE ADDING 17 FOOT BY 35 FOOT PLAYROOM ADDITION TO THIS HOME
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATIQN ,
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
Electric Plumbing i _Sprinklers
Total Sq. Ft of Construction: 595
Cost of Construction: $ 55,000
_ Shutters Windows/Doors _ Pond
_ Generator Roof 5/12 Pitch
'l
Sq. Ft. of First Floor: 1500
Utilities: —Sewer _ eptic Building Height: 16
ow R/LESSE
CONTRACTOR
NameJOHN EDGAR
Name: HAROLD DEAN ROBERTS
Address:5512 PINETREE DR
Company: DETAILED ENTERPRISES INC
City: FT PIERCE FL State: _
Address:565 NW CORNELL AVE
Zip Code: 34982 Fax:
City: PORT ST LUCIE FL
Phone No. 772 475 8349
Zip Code:983 Fax:
E-Mail:john edgar@bellsouth.net
Phone N0772 475 0112
Fill in fee simple Title Holder on next page ( if different
E-Mail deanroberts2009@gmail.com
from the Owner listed above)
State or County Licensecrc1331073
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 CONSTRUCrTIONLIEN LAW INFORMATION
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
N a me: JOE SIMMONS
Name
Address: 7s19 GRAMERCY DR
Address:
City: ORLANDO
I State: FL
City:
State:
Zip:32818 Phone4074541890
I
i
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 attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature 'of Holder
STATE OF FLORIDA
STATE OF FLORID&�
COUNTY OF S % �f�
COUNTY OF J - 40(cf6l,
S�woJn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
/_ P48ical Presence or Online Notarization
!/PWsical Presence or Online Notarization
this ng 1-day of & �t)2020 by
this,2!L day of 2020 by
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Name o'f person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification ✓�
Type of Identification
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Type of Identification
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