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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'��D.� D S'CBNNEp Permit Number: I'III c�3 F
Lucie Co
r., BOingrmit Application AN
J 82020
Planning and Development Services
Building and Code Regulation Division= Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ✓ Resi,dehtiale County; -.FL
PERMITTYPE:
p�.tnalh9 eowllv�wcic�.
PROPOSED IMPROVEMENT LOCATION:
Address: 52Zb /}O hifta- ?We.
Property Tax ID#: I?Il— ADC! GINS'' 00015- Lot No. 4--
Site Plan Name: Wr44tN k0re — ' rta-s'Pi J— Block No. 3
Project Name: V-006-u�
DETAILED DESCRIPTION OF WORK:
n/un/ Comfy lion
SA les Cerrt--
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all
_Mechanical _Gas Tank _Gas Piping
that apply:
Shutters
Windows/Doors
v/ Electric Plumbing
t/Sprinklers
_ Generator
_1/ Roof S= Pitch
Total Sq. Ft of Construction: yl 119
Sq.
Ft. of First Floor:
i 01(p
Cost of Construction:$ 9yI/le!•92
Utilities:
a[Sewer _Septic
r 11
3
Building Height:[�31y_
OWNER/LESSEE:
CONTRACTOR:
Name
Kevin Borkenhagen
Name: �nm 5508L1
Address: Aool ftttnttAM ?21%ld
Company:K• tbWt%0N4A fL V4L*L 0CMM}IOm I{�
City: am iVUX G.G% Stater
Zip Code: 77.31424 Fax:
Phone No. I%1-3loU '"300
Address: b(pol RW &Am %%&-
City: Br(Nl V' qpe,P(, State:
Zip Code: 334� Fax:
Phone No 51ol-31ioy-3316
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail KWtV) Y% & Ign4V- COW"
State or County License I.}'7�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
[SUPPLEMENTAL CONSTRUCTIO,N LIEN LAW INFORMATION:
City:
Zip:,
FEE SIMPLE TITLE HOLDER:
Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State: City: State:
Zip: Phone:
Not Applicable I BONDING COMPANY: _Not Applicable
Name: Name:_
Address: Address:
WE
Zip:
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOBICLf O&EOMME ENT."
10
Signature of Owner/ L ontractor as Agent for Owner
Signature ont ctor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ?&(_
COUNTY OF me
The forgoing instrument was acknowledged before me
The fo going instrum nt was cknowledged before me
this � day of c1b , 20',0 by
this day of fAJL� 20A9by
Kevin Borkenhagen
Olbsftm S?AL.\
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 �f I. o
�/Di AAMn U-/
Produced
(Signature of otary Public-Stat Fix ,,..F P
KEVIN WIRTN
(Signature of otary Public- Statd of F .108 KEVIN WIRTH
?,/,•��;`: Notary Public -State at Florida+Q
mission
dFl� mission: GO 917671
Commission No. PSi.�To'
3cr
;�?:�ajl Notary Public of Fly
,,22ff"" h� Ccmmission. GO 917C
Commission No. W' �l�y Comm. Expires Sep 29,
............
n9'( Y mm. Expires Sep 29, 2023-BCMeC[hreu;h
2cnGeC through National Notary Assn.
Naticral Notary
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RECEIVED
DATE
COMPLETED
Rev. 2 j // 15