HomeMy WebLinkAboutGibney_BuildingPermitApp_NotarizedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date- 8/15/2020
Permit Number:
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
PERMIT APPLICATION FOR: Karen Gibney
PROPOSED IMPROVEMENT LOCATION:
Address: 771 SE Solaz Avenue, Port St. Lucie, FL 34983
Property Tax ID #: 3419-545-0055-000-9
Site Plan Name:
Project Name: T
'0906' /7
DETAILED DESCRIPTION OF WORK:
New Electrical Meter No Second Electrical MeterNo
CONSTRUCTION INFORMATION:
Lot No. 17
Block No. _—
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:
Sq. Ft. of First Floor:
$� Utilities: —Sewer _ Septic Building Height:
Cost of Construction:
OWNER/LESSEE:
Name Karen Gibney
Address:771 SE Solaz Avenue
City: Port St. Lucie State: —
Zip Code: 34983 Fax:
Phone No. (772) 418-5843
E -Mail. kazee122@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:(4aig Herlan
Company:CoastL'rfe Pool & Spa
Address:2201 SE Indian St
City: Stuart State: FL
Zip Code: 34990 Fax:
Phone N0772-266-4355
E -Mail craig@coastlifepools.com
State or County License CPC1 459210
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name'
Address:
rirv•
Zips Phone:_
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:
Address:
City:.
Zip: � Phon(
o obtain a permit to do the work and installation as indicated.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made t
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
structure. Pleasecconsult with your owners Association and rules, bylaws
deed far any restrictions which may aprohibit such
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
result in
twice
or
WARNING TO OWNER: uourroperty A NoticRecord
e of Commen ement must be fre orded inathepubl cf ecords of St.
improvemen y p
Lucie County and posted on t ore bommenun the
work or recording on Iou�N tice of Commencement.
consult
with lender or an atto
of Owner/ L see/Contract9 as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor
o (or affirmed) and subscribed before me of
nPhysical Presence or Online Notarization
this day of 2020 by
N661e-of person making statement.
Personally Known OR Produced Identification Z
Type of Identification
Produced A Y
W( ig ture of No ry Public- 5
Commission No.14 / � 0
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
ev 5757
Signature of Co c%cense Holder
STATE OF FLORIDA v�
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Th -is day of 2020 by
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification
Produced „
3 ) Notary Public State of FI nd6ig tur of Notary Pu
Julie A Hunter g fi
y Commission GG 1601'E fission No.
�agYolfas 1 111 412 0 2 1
SUPERVISOR PLANS I VEGETATIO
REVIEW REVIEW REVIEW
f of FloridI
74� tate of Flonda
3 Julie u of
my Commission GG 160178
.A TURTLE MANGRO`
REVIEW REVIEW