HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Budding Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential XXXXXXXXXXX
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address: 12326 NW Harbour Ridge Blvd
Property Tax ID #: 4426-600-0007-000-1
Site Plan Name: Anthony Potter
Project Name: Potter Residence
Removal of Pool Fence and Installation of Pool Screen Enclosure
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit– check all that apply:
Lot No. 6
Block No.
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 10900.00
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
NameAnthony D. Potter
Address: 12323 NW Harbour Ridge Blvd
City: Palm City State: _
Zip Code: 34990 Fax:
Phone No. 772-631-7855
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:Craig Rice
Company: Pioneer Screen LLC
Address: 3290 SE Slater Street
City: Stuart State: FL
Zip Code: 34997 Fax: 772-283-3028
Phone No 772-283-9197
E -Mail Bev@pioneerscreen.com
State or County LicenseSCC046064
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.
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
kith lender Qkr an attorney before commencing work or cordin our Noti e of Commencement.
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SiVit re o ?Own er essee/Contractor as Agent for Owner
Signatu oftrac or/License Holder
STATE OFQ A
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Sworn,td"(or affirmed) and subscribed before me of
Swor -to (or affirmed) and subscribed before me of
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-P sical Preser� or Online Notarization
thf . day of tL 2020 by
th�LhyicaI Prese aor Online Notarization
day of 2020 by
Name of'orson making statement.
Name of pe on making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
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.Produced
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ignature of Notary u .F"�te�
4 BEV L. HADDAD �
(Signature of Notary P - f Florida )
Commission No. 4 F�YCOtv1�9 �j GG 009383
j Fc EXPIR�S July 6, 2020
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Commission No. I S �fQ DDADD
MY CDM iuN # GG 409363
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