HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 08/18/2021 Permit Number:
Sit:, L-k;LL
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Patio Screen Enclosure
'PROPOSED IMPROVEMENT LOCATION:
Address: 3009 NW Radcliffe Way, Palm City, FL 34990
Property Tax ID #: 4425-703-0050-000-0
Site Plan Name: Rlverbend
Project Name: Gray Residence
DETAILED DESCRIPTION OF WORK:
Patio Screen Enclosure
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
/N
Lot No. 45
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: 225' _ Sq. Ft. of First Floor:
Cost of Construction: $ 2440.00 Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
Name
-flyan D. Gray
Address: W -Radcliffe Way
I City; Palm City State: FL
Zip Code: 34990 Fax:
Phone No,239-641-8487
E-Mail: rdarav169(@amail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Jason D Prince
Company:Prince Development Group, Inc
Address: 3608 E. Industrial Way Ste. 1
City: West Palm Beach State: FL
Zip Code: 33404 Fax:
Phone No 561-840-3300
E-MailPrincedevelopmen!group@gmail.co
State or County License CBC1256464
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.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: �,C tCfhPE
Address: I-'[ ]10039
City: T�ma� State:
Zip: ne_81.'� 7_�,,-q�l.`i.5
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:—
_X_ Not Applicable
MORTGAGE COMPANY: _. Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
UWNtK/ 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 lends attorney before commencing work or recordingyour Notice of Commencement.
Signature of Owner/ ssee/Contractor as Agent for Owner
STATE OF FLORIDA Palm Beach
COUNTY OF
Sworn t9 Or affirm ) and subscribed be v e me of X Physical Presence or Online Notarization
this day of , 20by
Jason Prince
Name of person making statement.
Personally Known X OR Produced Identification
Type of Ids
. P ifl tn Produced '
-T5lgnaturEvdf NcAalIRfdbli - State of Florida )
Commission No. GC7 5,6 (.4 3 (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev Vzmr—
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CHERYL L AllIZZI
Commission # GG 250143
ExlA!rs August 30, 2022
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Bond odIhru5udpotNotary 8oryloo
SUPERVISOR I PLANS VEGETATION I SEA TURTLE I MANGROVE
REVIEW REVIEW I REVIEW REVIEW REVIEW