HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLI INFO TLIST BE CON-
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Permit Number: Q
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RECEIVED
Building Permit Application FEB 2 3 2021
Planning and Development Services .
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-11578
Permitting Dapartment
Residential SX Lucie County
PERMIT APPLICATION FOR: Screen Enclosure with existing slab I
Address: 120 Pepper Lane Jensen Beach, FL 34957
Property Tax ID #: 4511-503-0025-000-6 Lot No.19
Site Plan Name: Block No.
Project Name:
Install new screen enclosure with existing slab
New Electrical Meter Second Electrical Meter
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 Cons rumen" 2, V S F
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Cost of Co11� st—rruuc On $ Utilities: _ Sewer _ Septic Building Height:
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NameKamala Staniszewski
Address:120 Pepper Lane
Name: Gregory Whigham
Company: WO Gregory Construction Inc.
City: Jensen Beach State: _
Zip Code: 34957 Fax:
Phone No.774-253-1349
Address:5810 Hickory Drive -
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone N0772-237-0714
E-Mail:.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail allfloridaretrofits@gmail.com
State or County License CBC1 253414
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.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
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.
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Signature of O ne / Lessee/Co r ctor as Agent for Owner
Signa re of . o tract/Lice a Hol er
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF o ' ` l 1^i����E,
COUNTY OF
Sw n to (or affirmed) and subscribed before me of
Swoyfi to (or affirmed) and subscribed before me of
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Physical Prese or Online Notarization
Ph ical Pres or Online Notarization
?day
this day of 2021 by
('�_)Iylps� nt:� kklkqy-� �Am
this of 202p by
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Name of per n m- alfing statement. J
Name of persor4haking stMtement.
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Personally Known OR Produced Identification t""/
Personally Known OR Produced Identification ✓
Type of Identifica '
L
Type of Identific
Produced —
Produced
(Signature of Notary NUDE! State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
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DATE
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DATE
COMPLETED
Rev. 5 6 20