HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED v
SCANNED PermitNumber:
BY
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE: Screen Room
PROPOSED IMPROVEMENT LOCATION:
St. Lucie County EnA
ECEIVED
Building Permit ApplicatipR 12 _019e EouFl s Ps'-rrnrlEgng
Commercial Residential X
Address: 610 Ulrich Rd Fort Pierce, FL 34982
Property Tax ID #: 3410-603-0044-000-9
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Build a 9' X 18'screen room with an insulated aluminum roof on existing concrete
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: I Z�D
Cost of Construction: $ 4150.00
_ Generator
Sq. Ft. of First Floor:
Lot No.29,30,31
Block No. B
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:_
OWNER/LESSEE:
CONTRACTOR:
Name Donna Witherow
Name: David Miller
Address: 610 Ulrich Rd
Company: A Quality Construction, LLC
City; Fort Pierce State: _
Zip Code: 34982 Fax:
Phone No. 772-485-0261
Address: 3531 S 25th St
City: Fort Pierce State: FL
Zip Code: 34981 Fax: 772-343-0805
Phone No 772-343=-0805
E-Mail:
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Aquality0l@bellsouth.net
State or County License CBC1257739
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name' RA Dunlea
MORTGAGE COMPANY:
Name:
.yG Not Applicable
Address:1513 Cervantes Place
Address:
City: The Villages State: FL
Zip: 32159 Phone 772-285-64u
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY:
Name:
�C Not Applicable
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMBCEMENT MUST BE RECORDED AND
POSTED ON THOB SITE BEFORE THE FIRST INSPECTION. IF YOU 1 W NO TO OBTAIN FINANCING, CONSULT
WITH YOUR LE ER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sig
Sig ure of Owner ssee/Contractor as Agent for Owner
Sig np re of Contractor/License Holder
OF FLORIDA
COUNTY OF 5�r . LQ c �e
STATE OF FL%TA
COUNTY OF 7�t •
The forgoing instrument was acknowledg before me
O':?
The forgoing instrument was acknowledge before me
this �day of � 20 by
this\a dayof3 C 20t\ by
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 Z 1p L—
Produced
(Signature of Notary P lic- State o
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RECEIVED
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DATE
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Kev. 2/7719
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