HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: Ay `fop I Permit Number: 'ro
S``t�. LuGUL - --
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:
P'RQ.POSED'IMPR'OVEM_ENT LOCATION;`..`.
Address: 47 Aqua Ra Drive Jensen Beach FL 34957
Property Tax ID #: 4511- I811-0022-240-5 I (� Lot No.
Site Plan Name: ' �q \2s�,,,Ai ��VAW%A!n-q ?6�1 �nS}c��g-�tU�1p _ l y�t��g 5/ Block No.
Project Name: _ �e s� �16pi-q_\g5; SU -M N1!L,.i
DETAILED DESCRIPTION.OF V1/ORK:
New Electrical Meter�f �_ Second Electrical Meter NO (Affidavit required)
CONSl'RU_CTIONINFORMATION: :"
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
X Electric W Plumbing V Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: t(O0 Sq. Ft. of First Floor:
Cost of Construction: $ SS �782,DU Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE
-CONTRA. CTOR
Name �i�,�r�i—��� er"'r
rNa�m• p• � � n� -. t.�., _ _ _�D
�Company" ...... .ra<�cyaP_;0i
Address:
Address:47 Aqua Ra Drive
City: Jensen Beach State: FL
ZipCode: 34957 Fax:
Phone No. 772-696-2949
City: ty: 6Q��P.F�OS ��Q�Rftfstate:
Zip Code: �ofi Fax:
E-Mail:_ benglert@proctorca.com
Phone No 33a - 3KN -16( S
E-Mail Povk S Niv -z- (0, a 01 • coc. 1
Fill in fee simple Title Holder on next page ( if different
State or County License CPC -0.5 -? 3 SS' /063S3
from the Owner listed above)
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.
;SUPPLEMENTAL'CO NSTRUCTION IIEN LAW 1NFOR MATIO'N ,
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: of 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 inte d to obtain finan ng, consult
with lender or an attorneybefore commencingwork or recordingour Noti of men a errE.
Signature of Owner/ Lessee/Gaiffector as Agent for Owner
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STATE OF FLORIDA /� � �a HEATHER
COUNTY OF_�Adici h b, er ate of Flori
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My Commi
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notariza Februar,
this /,31"- day of M )1% _l , 20 Z j, by
Name of person makingstatement.
Persona r wn /` OR Produced Identification
Typ of Iden ific tion Produced
( gnature of N tary Public- State of Florida )
Commission No. (Seal) TANIASWAHA
MY COMMISSION # HH 019235
4-EXPIRES: November 8, 2024
odF ;R• ` Bonded Thru Notary Public Underwriters
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# G G 183
Sion Expir
06,2022