HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE
I INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t2-' J(.PPermit Number: I lc�'- 0 0
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Building Permit Application
DEC 2 6 2017
Planningand Development Services
p PFR'I117lNG
Building and Code Regulation Division St. Lucie COUnty, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential yes
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 28 DA LAGUNA -19 6¢�-TA DA Lau_ vx-,a,
Legal Description: SEC 01/TOWN 34S/RANGE39E
Property Tax ID#: 1301-111-0001-000-5 Lot No.2A/2+
Site Plan Name: OTTO PLAGGE Block No.
Project Name: OTTO PLAGGE
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: \Aa m
TEAR OFF OLD SHINGLE ROOF AND INTALL NEW 3 TAB SHINGLES
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that appy:
_HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: 2800 Sq. Ft.of First Floor: 1000
Cost of Construction: $ 3 3j, "' Utilities: _Sewer _Septic Building Height: 8
OWNER/LESSEE: CONTRACTOR:
Name Name:
28 _L — JOHN CANNON
Address: iS�A J)P, LIL V�1, Company:
City: FORT PIEHUE State:_ Address: 7901 Ul THUS PAHK BLVD.
Zip Code: 34951 Fax: City: FOHI PIEHUE State:
468-0202 — 34951 7Phone No. Zip Code: 772-4680202 Fax: -468-027
E-Mail: Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail: jgcannon root IC oU .com
from the Owner listed above) State or County License: 1466 W)&_A89
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: COOK&MENARD AF-CHT Name:
AddreFS : AVE Address:
City: State: City: State:
Zip: 34900 Phone: 11246071,51Zip: 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 financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
ign ure of Owner Lessee/Agent ignatur of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA � I
COUNTY OF 1C1 E COUNTY OF �_) . LU(f�(
The forgoing inst ment was acknowledged efore me The for oing instr ent was acknowledged before me
this QLWay of 20 by thisLUp day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
1 �, C9--�
CJ�-�
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known V/ OR Produced Identification Personally Known V/ OR Produced Identification
Type of Identification Produced Type of Identification Pro u e
KAREN S. NIELSEN
��� �AY' UB i, KA R E N S ,`... ,,�,:
Commission No. -= .( V�SEN Commission No. com�B�l�n a FF 115637
�s ssion 115637 = My Commission Expires
My Commis on Expires '%,;a�«':•`� June 12, 2018
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS