HomeMy WebLinkAboutBuilding Permit Application - Bracken Rd All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : Permit Number:
�To
o _
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone : ( 772 ) 4624553 Fax : ( 772 ) 4624578
PERMIT APPLICATION FOR ,
P vOPQSED IMPRC?UEM, NT,OCATJO.
Address : 125 NE Bracken Rd Port Saint Lucie , FL 34983
Property Tax ID # : 3419-570-0023-0004 Lot No . 10
Site Plan Name : Block No . 74
Project Name : Agnieszka Loaza
DETAILED DESCRIPT) C#IU OF 1NURK
, Z11_ 1. 5 wt hckwS
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION
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 Building Height :
O1rVN ER/LESSEE : % CO.NTRAC_ TOR :
Name Agnieszka Loaza Name : Scott Berman
Address : 125 NE Bracken Rd Company : Florida Window & Door
City : Port Saint Lucie State . _ Address : 1125 N Dixie Highway
Zip Code : 34983 Fax : City : Lake Worth State : FL
Phone No . 863455-0116 Zip Code : 33460 Fax :
& Mail : Phone No 561 -3404300
Fill in fee simple Title Holder on next page ( if different E- Mail howard@floridawindowanddoor. com
from the Owner listed above) State or County License 28576
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 .
SUPPLEM € NTAL CaNS1'FtUCTION IIEN I.Aw INF{flRMATION,
DESIGNER/ ENGINEER : _ Not Applicable MORTGAGE COMPANY: — Not Applicable
Name : Name :
Address : Address :
City : Stater 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 .
Signatu e of Owner/ Lessee/Contractor as Agent for Owner Signature of Contrat't icense older
STATE OF FLORID STATE OF FLORIDA
COUNTY OF � �t � e COUNTY OF Palm Beach
Sviorn to ( or affirmed ) and subscribed before me of Swo to ( or affirmed ) and subscribed before me of
vz- Physical Presence or Online Notarization hysical Pres nce or . Online Notarization
this °� r21ay of aQ � c� � bXc this day of 620 g by
��
Agnieszka Loaza Scott Berman y
Name of person making statement. Name of person making statement.
n
Personally Known OR Produced Identification OC Personally Known x OR Produced Identifi tion
04
Type of Identification Type of Identification 1=Z
ProducedlL CM\,e s UL C� �.-c Pr d ed 3mw
(Signature of Notary Pu icrQ
r` dot Roberts (Si ure of Notary Public- State of Florida ) N w
My Commission GG 937056 w G) a
d-` "' "p„��� �'�4rZo23 Commission No. ( Seal ) �'
Commission No. p o
a
m
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev .