HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/17/2020 Permit Number: a 1\�
RECEIVED
�Q
Building Permit Application Nov 1;9 2020
Permitting Department
tanning and Development Services St. Lucie county
Building and Code Regulation Division Commercial XX Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: Master Bath tub to shower .
PROPOSED IMPROVEMENT LOCATION r
..
Address: 9550 S Ocean Drive#1009 Jensen Beach, FL 34957
Pr I operty Tax ID#: 4502-601-0093-000-6 Lot No.02/37S/41 E
Site Plan Name: Block No.
Project Name: Master Bath tub to shower
4 DETAILE'b DESCRIPTION OF,'VUORK $ kf
I
Master Bathroom change tub to shower. Change valve, add diverter, shower pan and drain, new tile
Ni w Electrical Meter Second Electrical Meter
CONSTRUCTION I N`FORMATIO.N
i .,
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: 30 Sq. Ft. of First Floor:
Ci st of Construction:$ 5200.00 Utilities: —Sewer —Septic Building Height:
�OU1%NER%LESSEE Y; My'' COIVfiRACTOR
_., .
'NameJohn Pollak Name:Katherine La' Deene Dodson
Address:9550 S Ocean Drive#1009 Company:Agler Kitchen, Bath &Floors, Inc
City: Jensen Beach State:_ Address:1970 NW Federal Hwy Ste A
Zip Code: 34957 Fax: City: Stuart State:FL
Phone No.772-229-2963 Zip Code: 34994 Fax: 772-692-0070
E-Mail: Phone N0772-692-0077
Fill in fee simple Title Holder on next page(if different E-Mail ladeene@agierinteriors.com
from the Owner listed above) State or County License CBC1 250637
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 INFORMATIa
DESIGNER/ENGINEER: xx Not Applicable MORTGAGE COMPANY: xx Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: xx Not Applicable BONDING COMPANY: xx 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
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St.Lucie COUNTY OF St.LuGe
S rn to(or affirmed)and subscribed before me of S orn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarizati n Physical Presence or Online Notarizatio
this � 'day of AoVem 2020!by this �' day of w 1 2020 by
I• IIA� I lrl�Ll/ �JO 7 l co N •l I.. CA mv.J w
Name of person making statement. 0� Name of person making statement.
Personally Known x' OR Produced Identific iM w ' � Personally Known X OR Produced Identificat
Type of Identification c Type of Identification ti-
Produced o Produced ,
(Si nature of Notary Public-State of Florida) '�: (Signaturd of Notary Public-Stat�e of Florida
Ei J
Commission No. � (Sea) Commission No. V'lEA 1 6o )�/ (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
;RECEIVED
DATE
COMPLETED
i
ev. 5/6/20