HomeMy WebLinkAboutBUILDING PERMIT APPLPICATIONAll APPLICABLE INFO MUST BE
Date:
FOR APPLICATION TO BE ACCEPTED
Permit Number: A'QSWW
VEX,3w. =._wee SCANNED
BY
� _
Building Permit Application St. Lucie County
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: "� wl Ix,QW.J
Address:
Property Tax ID #:
Site Plan Name:
Project Name: _
'DETAILED DESCRIPTION OF WORK:
I CONSTRUCTION INFORMATION:'
Lot No.191
Block No.
0
Additional work to be performed under this permit — check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: /it -7 4` Sq. Ft. of First Floor: 14-7
Cost of Construction: $ c22ovo Utilities: _ Sewer _ Septic Building Height:
'OWNER/LESSEE`.
CONTRACTOR:
Name
Name: Ray Edwards
Address: :i4ap
Company: Affordable Screen Rooms Company
City: lei tsL State:
Zip Code: I Fax:
Phone No.
Address: 313 NW Aurora Street
City: Port St. Luce State: FL
Zip Code: 34983 Fax:
Phone No 772 626-4495
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail RAY@ASRC.US
State or County License 29118
It 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 CONSTRU%-.r, LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: _ of Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _'Not Applicable
Name:
BONDING COMPANY: _ of Applicable
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 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 RECORDING YOUR NOTICE OF COMMENCEMENT."
Signa Lessee/Contractor as Agent for Owner
c gn fe-ef actor License Holder
STATE OF FLORIDA
STATE OF FLORIDA
\
COUNTY OF ,c:o ,
COUNTY OF A�X�
The forgoing instrument was acknowledged before me
11 day ak'h 20C� by
The forgoing instrument was acknowledged before'me
this day 201� by
this of ofr
c� of ,)L pk
'��Cacdw � �.SlylwMn�
o•
Name of person makin tatement.
Name of persoA making statement.
Personally Known OR Produced Identificati�ort'
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced p "hw-4
Produu�c`(�e�/edL�� � r\�7\-17Un'@_ \ I\ s off" \h.(Signatu
a of Notary Public- SQte of Florida)
(Signature of Notary Public- Statebf Florida )
Commission No. a _ LASHAH-RAHMING
•
Commission No. ~ �:%P :.••. LA SHAHNAII(Sea*RAHMING
+1
"V -`:,_ MY COMMISSION # GG 275060
, (• •':, MY COMMISSION H GG 275060
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0 2022
I •`<iBF, SY�'e-Bonded
Thru Notary
biic Undervrtiters
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`` Bonded Thru Notary Pu
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REVIEWS
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PLANS
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
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DATE
COMPLETED
Rev. 2///1.9