HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 Permit Number:
A 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 CBDG Funding
PERMIT APPLICATION FOR: /PN
PROPOSED IMPROVEMENT LOCATION:
Address. Q t� .
Property Tax ID #: v _ 5 Lot No.—
Site Plan Name: lift-(— Block No. r ��
Project Name: R'Y'C (--
New Electrical Meter Second Electrical Meter (Affidavit required)
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 —/
f Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 2J�3 LR
Cost of Construction: $ 0��� Utilities: —Sewer —Septic Building Height: zo
OWNtR/LESSEE:
CONTRACTOR.
Name G
Name:
Address: ) Y
Company: k i
Address: qffl
City: JiaLi VCYCLState:
Zip Code: ��T�1-� Fax:
Phone No. _7_1 L k E-
Mail: \& n
City: � J State:
Zip Code: 'z> Fax:
Phone No —T-72— \:�Cl
E-Mail I Y
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
It 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
Name: `
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
INFORMATION:
MORTGAGE COMPANY: Not Applicable
Name: X_
Address:
City: State:
Zip: Phone:
Not Applicable I BONDING COMPANY: ,_lot Applicable
Name:
Address:
City:
Zip: Phone:
U1NNtK/ GUN I KAL I UK AFFIOVIT: 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 conflicts with any. applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 attornev before commenring work or rarnrrllna vni it nintiro of ('nm_..,.,,.,.,+
Signature of owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA "
/ 11C P
COUNTY OF
Sworr),to (or affirmed) and subscribed befor me of Physical Presence or Online Notarization
this �`J�"l day of 20�by
I S 6 U I mus
Name of person making statement.
Personally Known OR Produced Identification
Typ I n 'fic uced
i
nat ublic- St to 0 orida)
Commission No. (Seat)
tKA
:°�µ...ro THERINE HAVENS
^# MY COMMISSION #GG165030
EXPIRES: DEC 44, 2021
bonded through 1st State Insurance
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
P\/
MICHELLE R. MILLER, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 4943984 OR BOOK 4710 PAGE 2035, Recorded 10/27/2021 12:20:03 PM
PermitNbI,
State offlorida, County of St. Lucie
NOTICF, OF COMWNjC
Property Tay, 11) No, 1301-611-0359-000-4
The Undersigned hereby gives notice that improvement will be made tia certain real property,. and In aecordauct with
Chapter 713, Fibrida SI the faflowing. Wformation is provided in this Notice of Commencement.
Legal Ekscription of property and address ff avaflable 6704 Citrus Park BLVDFort Pierce, FL 34051
LAKEWOOD PARK-UNIT4. BLK 117 LOT 6 (MAP 13/01 N) (OR 728-2071)
General description of improvements Re -Roof
owner/jesm Gregory A Brock. & Jane L Brock
Address 6704 Citrus Park BLVDFjott Flew, FL. W.51
I
I �m.terest -to property., Owner
Fee Simple Title holder (if other tbanowner)
Address
conI Rhino Roof & General ConstTuiclibri phI 772-446-1139
Address WS 8 King HWY Port Pierce FL �4W Fax 4
Address Fax im
Amount of Bond
Lender
Phone tv
Addy m� Fax #
Persons within the State. of Ftorida designated. by Owner upon whom notices or other deer kimentsmay beseived as provided
by Section 71333 (a) 7., Florida Statues:
Name Phone 9
Address Fax
to addition to htmsel:, owner desigja2tes
phone 0! Fax #—
to receive a copy ofthe Lienor's, Notice as provided In Section 714-13 (1) (b), Florida Statutes. Expiration date ofnatice of
commencement, is one year from the date of recording unless a different date is specifted. WARNING, TO! OWN FR.-
ANY PAYNORM MADE BYIME OWINER AF1"FK'n-IE- EXPOIATION OF TM, NOTICE OF tX)&1MFN4CEMLN-T ARE UONSIDERED MMOPRR.
PAYMEM& UNDER CIL713413, FSr, AND CAN. RESULT IN YOCA PAYM TWICE FOR IMPROVEMENTS TO YOM PROMM A N()-nf-E- OF
CVft1MNCEWN3'T MUST HERECORODED AND POSTED ON THEJORSM BEFORE THE FUMMISPECTIM-N. IF YOU INTEND TDOBTALN
FNANCING, CONSULT WrTH YOUR. 12NDER OR AN KrPORNLY BEFORE COMMDXMqG WORK M RE-00RDINGY YOUR VG110E- Or-
CoMMENVNEW, le--x
State ofF1or1d1a,Qxv,nty*f5t tnt.r c.N
Acknowledged before me day of 20-1) by&g$AIZ4�ivt-k
who ts.2Ersoriafly knovwu to me or wito has produced as identification.
Signature or 13
Pubk Sta06 * of P4
Tftteb N";a Publig Commission Number KEN— =RAbeffwftJF-
I