HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 14 sl Permit Number: _
S'145forro!" Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
CBDG Funding
[ PROPOSED IMPROVEMENT LOCATION:
Address: 9106 r-+. Pidle 614 R. pitat
Property Tax ID #: 1,50- W4, MOD- cm-- 0 Lot No. 10
Site Plan Name: h6hr i-ed Block No.
Project Name: kP th- c �%1P
DETAILED DESCRIPTION OF WORK:
If s U8tV,1Ar V00f, AAA.1in U f i �vil�wlimes, �110
New Electr cal 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 _ 5hutters Windows/Doors
Electric Plumbing Sprinklers _Generator - Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ Utilities: —Sewer _Septic
Septic
_ Pond
Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name :� � A- A(rthl
Name: US Wifrgl(litJG l
Company:
Address: G-lolo • 1-mL I 'A
City: a,Vlilu State: EL
Zip Code. MS j Fax:
Phone No. E-
Address: �3 �,� S+' gy
City:` State:
Zip Code: IL Fax:
Phone No o,.-7-G401
E-Mail DA 19 e YDQfiY1ih''
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
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 LAM/ INFORMATION: I
DESIGNER/ENGINEER:
s 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 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, 1 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 tender or an attornev before commencing work or recording vour Notice of Commencement.
Signature of Contractor - or - Owner Bui( as applicable
STATE OF FLORIDA
COUNTY OF i t4 el 91W.-
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 11 day of Aurow , 20 14 by
tt. Ott = 1 ir'�s'rr t
.jM14At&erg
Name of person making statement.
Personally Known OR Produced Identification
Type of identification Produced
(Signature of Notary Public- State of Florida)
Commission No. (Seal) <if �wx•;
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MICHELLE R. MILLER, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 4966569 OR BOOK 4738 PAGE 2372, Recorded 12/14/2021 10:10:29 AM
Permit No.
State of Florida, County of St. Lucie
NOTICE OF COMMENCEMENT
Property Tax ID No. 1301-604-0160-000-0
The Undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
Legal Description of property and address if available
LAKEWOOD PARK -UNIT 4- BLK 35 LOT10 (MAP 13/11 N) (OR 851-2710; 3256-790)
General description of improvements Re -Roof of residence
Owner/lessee Deborah A Rector
Address 5706 Ft. Pierce Blvd, Ft. Pierce FL 34951
Interest in property: Owner
Fee Simple Title holder (if other than owner)
Address
Contractor M li W(,(yej p $ylt {t VA41, Inn— Phone # `1 i'� 5*6
Address ICI �'� , y�yv �•]����• Fax# _eil{J
Surety
Address
Amount of Bond
Lender
Address
Phone #
Fax #
Phone #
Fax #
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13 (a) 7., Florida Statues:
Name Phone #
Address
In addition to himself, owner designates
Phone #
Fax #
Fax #
of
to receive a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes. Expiration date of notice of
commencement is one year from the date of recording unless a different date is specified. WARNING TO OWNER:
ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER
PAYMENTS UNDER CH.713.13, F.S., AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCMENT. /7
Owner/Lessee,
or
Owner's or Lessee's Authorized Officer/Director/Partner(Manager/ Signature
QiN R. f
Signatory's Title/Office
State of Florida, County of If ulki{ 41W Acknowledged before me this —7 , day 20 1A by ��g�h �"{
wersons}lwn to me or who has produced t as identification.
Alt// Kyti+h N
Signature of Notary
.-Meduts
Type or Print Name of Notary (Seal)
Title: No#ary Public Commission Number
R�oyq.,,. IEViN NEUSAUER
;m. H„ MYCOMM ISSION#HH08"
ro EXPIRES: January 30, 2025
'..,o'tiv4"' Bowled TI. Notary PiPoAc W*W&n