HomeMy WebLinkAboutBuilding permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
1 k T
Building Permit Applicati®n
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 IMPROVEMENT LOCATION:
Address: 5500 St Lucie Blvd. dykj� Ca/
Legal Description:
Property Tax ID #:
Lot No,
Site Plan Name: Block No.
Project Name: Van Dam - 10623035
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
reroof 5 squares asphalt shingles
CONSTRUCTION INFORMATION:
CONTRACTOR:
T"
Moo oo V& NiyI
Name: Raquel Swanner
Add itiona I work to be nerformed under this permit — check
HVAC I _I Gas Tank F]Gas Piping
all appy:
_ Shutters
a Windows/Doors
1iElectric ❑ Plumbing
Sprinklers
Generator
Roof
Total Sq. Ft of Construction:
State or County License: CCC1331113
S Ft. of First Floor:
Cost of Construction: $ 2331.00
Utilities: Sewer []Septic
Building Height:
OWNER/LESS,,//EE:
CONTRACTOR:
T"
Moo oo V& NiyI
Name: Raquel Swanner
Address: 5500 St Lucie Blvd. Uylr}
Company: The Home Dpeot
City: Fort Pierce State: FIL
Zip Code: 34946 Fax:
Phone No.
Address: 6500 NW 12TH Ave. Suite 110
City: Fort Lauderdale I State: FL
Zip Code: 33309 Fax:
Phone No. (754) 224 - 2010
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: 1 V10t� �nor�r( (..ow�ag jC�11 i}Q�►�rVtnr }.(
State or County License: CCC1331113
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required,
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
PLANS
Name:
Address:
MANGROVE
Address:
City:
State:
City: State:
Zip: Phone:
REVIEW
Zip: Phone:
REVIEW
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 len er oan attorney before
co.m�nenc n2 work oG� emi-ding-your Notice of Comm,encemen r _
Si6atu
t/ Lessee
STg,E OF"FLORIDA
COUNTY OF JE Ll'tcft
The forgoing instrument was acknowledged before
me this '�Z- day of J kv,�,_ 20 Eby
i �et4 ""� � St�AV►
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known x OR Produced Identification
Type of Identification Produced - -
Commission No.
Revised 07/15/2014
re of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 4�- Lac`
The forgoing instrument was acknowledged before me
this 2 ay of J'.\ , 20_1 by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known x OR Produced Identification
of Identification Produced
TIMOTHY R. O'MALLEY
(COMMISSION#GG 1171 5_o
mission No.
EXPIRES: August 7, 2021
IMUTHY R. O'MALLEY
MY COMMISSION # GG 117935
EXPIRES: August 7, 2021
Bonded Thru Notary Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
CO M P LETE
INITIALS
/DCez 3035�