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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:— I (u
Fts
F MD- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:Delores A Schwwenk(EST)
4' PROPOSED Ml PROVEMENI LOCATION:743 Nettles Blvd Jensen Beach Florida 34957 --,. ,
Address: 4434 rra a—ra r4-.yrwrr4couniai iu r ai n, i iuTqua 3.i5D9
Property Tax ID#: 4502 501 0929 000 9 Lot No.743
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION Of WORK:Newy thick 3000 PSI concrete slab with fibermesh and one#5 reb r
New Electrical Meter Second Electrical Meter (Affidavit required)
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: 1805 +/- Sq. Ft. of First Floor:
Cost of Construction:$ 16,245.00 Utilities: —Sewer _Septic Building Height:
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OWNER/LESSEE: CONTRACTOR:
Name Delores A Schwenk(EST) Name: Robert E Burns
Address:4431 NW19th Avenue Company: BURNS AND SONS CONCRETE INC
City: Oakland Park State: FL Address: POST OFFICE BOX#2335
Zip Code: 33309 Fax: City: Palm City State: FL
Phone No. E- Zip Code: 34991 Fax:
Mail: Phone No 772 260 3726 or 772 260 0776
Fill in fee simple Title Holder on next page (if different E-Mail BurnsAndSonsuoncretelnC@gmaii.com
from the Owner listed above) State or County.License 25364
If value of construction is 2500 or more,a RECORDED Notice of Commencement is req red.
If value of HAVC is$7,500 or more,a RECORDED Notice of-Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City:' I State:
Zip: Phone Zip: Phone: I
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 conflicts with any applicable Homeowners Association rules,bylaws or and covenants that may,restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration pf 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 attorn before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORI
COUNTY OF
Sw _ r affir ed)and b r' ed before me of Physical Presence or Online Notarization
thi�y of 2021 by
Name of person making statement. \,
Pe onally Know OR ced ifi I n cation •
T pe o n Produced
(Signature of Notary Public-State of Florida)
! .
Commission No� AUTUMN N BURNS
� �°� .� j
*; MY COMMISSION#GG 248769
b� EXPIRES:September 18,2022
Bonded Thru Notary Public Underwdtem
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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