HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '7
Date: Permit Number: .� IQ� 0)��
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2,300 Virginia Avenue,Fort Pierce Ft_34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential, X
PERMIT APPLICATION FOR: 1►WOD
PROPOSED' INIPRQVEMENT LOCATIQN
Address: 6603 DELAND AVE,FORT PIERCE,FL 34951
Legal Description:LAKEWOOD PARK UNIT 10-BLK 132 LOT 18
Property Tax ID#:1301-612-0334-000-6 Lot No.18
Site Plan Name: Block No.
Project Name:WILLIAM&JEAN JUDD
Setbacks Front Back: RlghtSlde: Left Side:
DETAILEDsDL IPTION C!F WPRK. ,a
Replace 9 Windows
CONSTUCT
RION INFORIVI%1TION
.� nil,
ACIC11tionalworKtO'b. rorme unclerthISpermit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors
OElectric ❑Plumbing OSprinklers OGenerator O Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ 10,000.00 utilities: Sewer OSeptic Building Height:
OIIVNER/LE5SfE -.;,CONTRACTOR ; ,t
Name WILLIAM&JEAN JUDD Name:
Address: 6603 DELAND AVE Company:
City: FORT PIERCE State: FL Address:
Zlp Code: 34951 Fax: City: State:
Phone No, 772-595-0845 Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page( if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500.or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNST,RUCTI N LIEN LA.1N INFr RMATI0N�3 � t
DESIGNER/ENGINEER: _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:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count�yy makes.no rep resentation.that is,granting a permitwill authorize the permit holder;to build the subject.structure
which is in conflict-with anyy applicable Home,OwnersAssociation rules, bylaws orandcovenantsthat may.restrict.orprohibit.such
structure. Please consult au
Home.Owners Associatlon and review.your deed for any restrictions which may apply.
In consideration of the grant]ngof 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 5t:"Lucie CourityAMendments.
The following building permit applications are exempt from-undergoing a full concurrency review:room additions,
accessory structures;swimming pools,fences,walls,signs,screenrooms and accessory uses to another.non-residential use _
WARNING-TO OWNER'-Your fallure to Record a.Notice of:Commencement may resulflh 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 o'ran attorney before
comrnencin work or recordin y our Notice--of Commencement.
5Tgnature o Off/Agent/Less--4' Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA(?UNTY OF 6-L, Ll(,Gf L COUNTY OF ` 1'Cll{Y\
The forgoing instrument.was acknowledged before me The forgoing instru nt was acknowledged before me
this 21 day of RUB 20 14 by this Zd—day of 20_%by
k)iWA-M STL-J0n I Q
(Name of person acknowledging) (Nartfe of person-acknowledg]ng')
(Sign re•of Notary Public-State of Florida): IV 9 ffa ure o Notary Public-State of Florida}
Personally Known Y OR Produced Identification Personally Known, OR Produced Identification
Type`of Identification Produced peof'Identification Produced'
Commission No. P W HOWEL
co haSSION#M4a mmission No. RIG R1�71
X22 20 9 apav'v'u'et�. m"S51014 o GG00636
Revised 07/15/2014 EXpiR'=S June a Com
:vry;or'ti�' F;ordallo;aY's"'ic
(407)3gg.o153
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