HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CCItvii:irfTED FOR APPLICATION TO BE ACCEPTEu
Date: .- / tg-rRz� Permit Number: 2,00ii�-Oi ' l9l
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Address:
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Building Permit Application n o
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Commercial Residential
Sw'e,
Property Tax ID #: S`i 01 (,p b - 003ro- 000 -
Site Plan Name: Z �w66",Ckv.. r-%\l.Q/r le&A'1tz
Project Name:
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: 3Z CO
Cost of Construction: $ 9z0 O
_ Generator
Sq. Ft. of First Floor:
Lot No.3 Ve
Block No. S
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
'OWNER/LESSEE:
CONTRACTOR:
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Name: Ray Edwards
Address: vw
Company: Affordable Screen Rooms Company
City: State:
Zip Code: �' Fax:
Phone No.
Address: 313 NW Aurora Street
City: Port St. Luce State: FL
Zip Code: 34983 Fax:
Phone No 772 626-4495
E-Mail:
Fill in fee simple Title Holder on next page ( ifferent
from the Owner listed above)
E-Mail RAY@ASRC.US
State or County License 29118
If value of construction is $2500 or more, a RECORDED Notice of Commencement is regwrea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION- LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ✓ Not Applicable
Name:
MORTGAGE COMPANY: _/ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
Zip:
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 NOTICE OF COMMENCEMENT."
Signature of Con se Holder
ntractor as for Owner
SignatuVment
gent
STATE1
STATE OF FLORIDA
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COUNl�JlCOUNTYOF
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for nowledged before me
The for ping instrume�nt w``as acknowledged before me
this Tu20�by
this f daisy of o� ^'200by
Name of person m kings tement.
Name of person making statement.
Personally Known O roduced Identification
Personally Known OR Produced Identification
Type of Identificat' n
Type of Identification
Produced �/
Produced
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(Signature of Nota
(Signature of Notary Public- State o Florida 1
`1""" ELLEN UGHN
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Commission No. =_° kEStata of Flojb� otary Public
Com y' ELLEN VAUGHN I)
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Commission Expires
R5 a e o loritl-NotaryPublic
�?Commission # GG 270079-.?,.My
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SUPERVISOR
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COUNTER
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REVIEW
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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