HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/21/18 1Permit Number:
Building Permit Application SCANNED
Planning and Development Services BY
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xx
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: .,
Address: 349 NE Bracken Rd
Legal Description: RIVER PARK -UNIT 9-PART C BLK 82 LOT 5 (MAP 34/21 S) (OR 3429-856)
Property Tax ID #: 3419-570-0125-000-9 Lot No.5
Site Plan Name: Block No. 82
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF'WORK "
Pour concrete for backpatio10x15 2,
4" thick i� / It, b 0 (2— Ikea`
3000psi — N 0
8x8 footer(1) #5 rebar
+ 1' extension along back of home � Vx C #A. Ali- (oL
CONSTRUCTION INFORMATION:
itiona wor to e e orme under t—checkispermit a apply:
0HVAC LiGasTank []Gas Piping _Shutters ❑Windows/Doors
11 Electric 0Plumbing Sprinklers 11 Generator .Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 2050.00 Utilities:Sewer 0Septic Building Height:
OWNERAESSEE: ' `
CONTRACTOR:
NameWynthea Griffith
Name: Jose Vdes
Addressi349 NE Bracken Rd
Company: Josh Concrete Perfection
City: Port St Lucie State:FL
Zip Code: 34986 Fax: None
Phone No. 772 672 0237
Address: 383 SW North Shore Blvd
City: Port St Lucie State:FL
Zip Code: 34986 Fax: None
Phone No. 772 812 5066
E-Mail: Josbconcreteperfection@hotmaii.com
E-Mail: None
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: 25230
Nvalue of construction Is S2500 or more, a RECORDED Notice of Commencement is required.
SUPPCENIENTAUCONSTRUCTION UEN�t:AW'INFORIVIATION
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone q
City: State:
0p: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address: 383 SW North Shore Blvd
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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 recordingvour Notice of Commencement.
Signature of 0 n L ontractor as Agent for Owner
Signatur ontrac or Icense Holder
STATE OF FLORIDA r •
COUNTY ��
STATE OF FLORIDA ^
Sa- LUG
OF L U�
COUNTY OF LX
The forgoing instrument was acknowledged before me
The forgoing instrunr Bent was acknowledged before me
this �day of Z)E 0 20�by
this -Li dayof )i C 20_L!�`by
Yt•,%c • VCk.R 5,
5 Ose - V t ci es
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of identification ))))))
Produced Fif �I _
I In
Produced D�
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No��� ""4> %,, (Se@ILLEN VAUG HN
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DATE
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DATE
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Rev.8/2/17