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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: V V
Building. Permit Application
Planning and Development Services RECEIVED
Building and Code Regulation Division Commercial ReSiderltic'40 .10 7071
2300 Virginia Avenue, Fort Pierce FL 34982.
Phone: (772) 462-1553 Fax: (772) 462-157&. - Permitting Dapartment
. . . St. Lucie County,
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 12065 RIVERBEND RD.
Property Tax ID #: 4422-50/--0011-000-9 Lot No. 7
Site Plan Name: BAY ST. LUCIE 22/375/40E Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Extending existing concrete pool deck by 4" all the way around Pool(NO FOOTER) 3' wide concrete sidewalk from pool deck to.drlveway. 12'x12' concrete slab
All concrete will be 4" , 3,000 PSI (NO FOOTER) Termite Treated, Visqueen Vapor Barrier on termite -treated soil
All concrete well within the setbacks, No fill required
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: 850 Sq. Ft. of First Floor:
Cost of Construction: $ 2,300.00 Utilities: —Sewer , Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Gifford Hamill
Name: John Cook
Company: Design Concrete & Masonry
Address: 12065 Riverbend Rd.
City: Port St. Lucie, State: _
Address: 769 NE- Galilean St.
Zip Code: 34984 Fax:
City: Port St. Lucie State:
Phone No. 603-661-5433
Zip Code: 34983 Fax:
E-Mail:
Phone No 772-233-9049
E-Mail
Fill in fee simple Title Holder'on next page ( if different
State or County License 20972
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.
SUPPLEMENTAUCON.STRUCTION•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.
Inconsideration 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.
Sig ture of Owner/ Lessee/Contractor as Agent for Owner
S' natu of Contractor/License Holder
STATE OF FLORID/4��7
TE OF FLORIDA
COUNTY OF � L..t�l��—
COUNTY OF S-� Lclr�ct
Sworn affirmed) and subscribed before me of
Sw rn (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this `day of /�i%�l./�'� 2020 by
this 3a day of 202JI by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Iden
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Personally Known OR Produced Identification
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