HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMhiEfED FOR APPLICATION TO BE ACCEPTED`
Date:
June 4, 2020 Permit Number:
ST. LUCIE
COUNTY �s _.
Building Permit
Planning and Development Services v
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
'PROPOSED IMPROVEMENT LOCATION:
Arlrkwm- 9940 S Ocean Drive Unit G-5 Jensen Beach, FL 34957
Property Tax I D #: 4502-502-0005-000-9
Site Plan Name:
Project Name:
I JUN 2 9 2020
ST. Lucie=h, permitting
Residential
Lot No.
Block No.
[DETAILED DESCRIPTION„OF WORK „ ,,
yr. p .. ,, �• '.. �S i. 9. di � 'v,
1 1 I 1 U Iv�VW v , vv 1 • • a. v— v—v yr — _
ft movL 1, 0 Lltii ell)
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: zwo ` I Sq. Ft. of First Floor:
Cost of Construction: $ 1*0. G3 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
'CONTRACTOR:'
Name Jay Thomas Phipps
Name: 5M J'nl I)O-Asp,
Address:1000 SW 12th ST Apt 215
Company: 'rtA 1 h i 1,yo rJ 1 GLLV- 5, VLL
City: Fort Lauderdale State: f-L-
Zip Code: 33315 Fax:
Phone No.
Address: 3$O I S. �V1i a to
V( V-
City: f1A� ?UD rw State:,
Zip Code: elf IOZ Fax:
Phone No-I.1-- 01113
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail SI-LeLe-& Cd Aw .1 tL t'v. kAVLW5•
State or County License Gul g5q4"I
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.
SLIPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ra Not Applicable
Name:
MORTGAGE COMPANY: xx Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: xx Not Applicable
Name:
BONDING COMPANY: xx Not Applicable
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 Countmakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cc 14ict 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 Counvxand posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lendbr cir an attornev before commencing work or recording vour Notice of Commencement.
Owner essee/Contractor as Agent for Owner
'si ma - :XFLORIDA
Signature of Contractor/License Holder
STATE 9
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STATE OF FLORIDA
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COUNT*OF �A
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization
_ Ph sical Pres nce pr_ Online Notarization
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this 1��ay oppf J (.t f�P . 2020 by
this IWV8ay of 2020 by
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Name of person making statement.
Name of person making statement.
Personally Known A OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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Si
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Commission No.
16950
Commission q GG 169508
.':' f �11�sD"ember19.2021
CO
issionNo.�1 �r0I
Commission #GG1¢950E
o f (6d December19,2021
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REVIEWS
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ZONING
SUPERVISOR
PLANS
VEGETATION
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MANGROVE
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DATE
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Rev.5/b/ZU