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All APPLICABLE INFO MUST BE COMPLEI0 FOR APPLICATION TO BE ACCEPTED
Date: 1-21-21 Permit Number:
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91ro �17 ff�liT� RECEIVED
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(Building Permit Application Permitting Departme
Planning and Development Services I St. Lucie Count,
Building and Code Regulation Division Commercial X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 NCO)
PERMIT APPLICATION FOR:ACCESS RAMP
I'KUF'UStU IIVINKUV-tMtN I LUL�'H�I�IUN �. '�_. '
Address: 1901 S 34TH AVE.
Property Tax ID #: 2417-702-0074-000-0 Lot No._
Site Plan Name: Block No.
Project Name: WEEKS
ADQ,C. --- ACESS RAMP ��1 ',K4 1 1 �_ /
New Electrical Meter Second Electrical Meter
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:
Cost of Construction: $ Utilities: —Sewer Septic
/7 ki * a tr%-% ' -n V0 V_
Building Height:
OU1tNf R/$tESSf E =-
g C-ONTRACTO
NameTOM WEEKS
Name:COASTAL BUILDING CONTRACTORS,LLC
Address:SAME
Company::"'---,"
City: State: _
Address: 7.51'SOUTH SW-MACEDO BLVD
Zip Code: Fax:
City: PORT ST1UCIE State: FL
Phone No.,
Zip Code: 34983 - Fax: 772-879-0110
E-Mail:
Phone N0772-879-2440
Fill in fee simple Title Holder on next page (if different
E-MailSTORRES@COASTALBC.US
from the Owner listed above)
State or County License CGC1521176
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.
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Sk CONSTR.¢ GTION LIEN LAW gIN.FORMgTION
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}PsPLLIIaENTAL
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY:
x— Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY:
x 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 recordjng your Notice of Commencement.
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Signature of O ner/ Lessee/Contractor as Agent for Owner
Signature o*-e6ntryctor/Licensdf H Ider
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF sA LL _._cam
COUNTY OF
Sn to (or affirmed) and subscribed before me of
wo
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this _ZL day of fie' by
this day of 2020 by
Name of person making statement.
Name of person making statement.
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
2otog� ?�eL� KATRINA KLUCINEC
o. mission No. * Co"lln # HH 003580
Commission No. (Seal)
Expires September 26, 2024
9rFOFF to¢� BoadedTluaBudget Notary Serv=
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