HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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CI'Date: '1 3 . Permit Number:
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mentomatimew Building Permit Application pio,,/ "9to'®
BuildingPlanning and Development Services 4 C and Code Regulation Division ce C U ent
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X ,
PERMIT APPLICATION FOR: Renovation
PROPOSED IM?ROVEMENT LOCATIQIN:: .,:
Address: 6507 Emerson Ave, Fort Pierce, FL 34951
Legal Description: LAKEWOOD PARK-UNIT 8-B BLK 5 LOT 5 (MAP 13/02N) (OR 1469-355)
Property Tax ID it: 1301-610-0075-000-6 Lot No.5
Site Plan Name: Block No. 5
Project Name: Bragg-Hurricane Loss Mitigation Repairs
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK j -€
Replace garage door
T a 3 '77,--.:,.. 4
A ' ry.
CONSTRUCTION INFORMATIONk
Additional
work to be kerformed under this permit–check all :11at apply:
EIHVAC _Gas Tank riGas Piping —Shutters I✓I Windows/Doors
ElElectric 0 Plumbing Sprinklers Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: Sc,. Ft. of First Floor:
Cost of Construction:$ $1,400.00 Utilities: _Sewer 0 Septic Building Height:
OWNER/LESSEE" "' �.,. CONTRACTOR , w_
Name Angela&Dave Bragg Name: Jose De La Hoz
Address:6507 Emerson Ave Company: DE LA HOZ BUILDERS, INC.
City: Fort Pierce State:FL Address: 258 Del Monte Rd
Zip Code: 34951 Fax: City: Sebastian State:FL
Phone No.772-359-6704 Zip Code: 32958 Fax: 772-589-8127
E-Mail: Phone No. 772-228-9723
Fill in fee simple Title Holder on next page (if different E-mail: hilda@delahozbuilders,com
from the Owner listed above) State or County License: CGC1514151
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION ,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:
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 Countmakes 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 i • -suit in your paying twice for
improvements to your property. A Notice of Commencement must •- recorde• . q d posted on the jobsite
before the first inspection. If you intend to obtain financing, co4 + len•-r •i.n attorney before
commencin: work or recordin: our Notice of Commencem-
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contr c-nse older
STATE OF FLORIDA STATE OF FLOR IDA �
COUNTY OF COUNTY OF lino. p3 co eit-
The forgoing instrument was acknowledged before me The forRin instru ent was acknowled efore me
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this day of ,20 by this I? day of AU- ,20 by
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Name of person making statement Name of pers + ',ttateme�ittRRYA.GARDNER
Personally Known OR Produced Identification Personally Known -,t`l° u aif i gg,af`Florida
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Type of Identification Type of Identification '�oFP., My comm.Expires Mar 26,2022 `
Produced Produced Bonded through National Notary Assn.
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(Signature of Notary Public-State of Florida) (Signature of N ry Public�•tate of Florida)
Commission No. (Seal) Commission No. 'T . )1f '' (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17