HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //
Date: C9 "�a� �� Permit Number: l� '
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Building Permit Application JUN 2 2 2017
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED fMPROUEMENT LOCATION
Address: 181 SE Selva Ct.
Legal Description: River Park- Unit 7-Blk 63 Lot 7(MAP 34/28S) (OR 3785-1289;3826-2226)
Property Tax ID#: 3419-550-0018-000-4 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
reroof 39 squares asphalt shingles l�� •�
CONSTRUCTION INFORMATION
Additional work to be DPrformed under t ispermit—check all appy:
HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 17500.00 Utilities:0 Sewer OSeptic Building Height:
01NN EF/LESSEE CONTRACTOR
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Name Paul Nguyen Name: Raquel Swanner
Address:181 SE Selva Ct. Company: The Home Depot
City: Port St Lucie State:FL. Address: 6500 NW 12TH Ave. Suite 110
Zip Code: 34983 Fax: City: Fort Lauderdale State:FL
Phone No. �. T Zip Code: 33309 Fax:
E-Mail: Phone No. (754)224-2010
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CCC1331113
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Si1PRLEMENTAL CONSTRl1CTION LIENLAW INFORMATION'
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 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 financi , on with lender or arLattorney before
co encin work or recor •n of Com cement.
Si ature f OV1qr ess 'Sign atur o Contractor/License Holder
STATE O ORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forg Ing instrument was acknowledged before The for oing instru ent was acknowledged before me
ME this day of JtArU— , 20 17 by this day of 0./— 20_17 by
1 ��k'e I `IL�JBi.H✓l•.�.� a we� �wOlN✓�.l.l
(Name of person acknowledging) (Name of pe son acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Seal —— .a�Commission No. (Seal) az�
ter••"Ne%. TIh10THY R.0'MA LEY TIMOTHY R.G`MALLEY
fi_t6 rr .s_ MY COAih SR a
EXPIRE&:August 7,2017 «-
E..f�;;t Bonded Thru Nota Public ? �',�__ , -' EXPIRE&:August 7,2017
Revised 07/15/2014 _Notary bn Urden•7fars I._ Notary Public UrdeRwiters {
r Bonded Th u Nota
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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