HomeMy WebLinkAboutBuilding Permit Application • ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED IJ 1. 7
Date: (4 'a ( D Permit Number: C U
;.7.answitiminiiim � — -..; RECEtBD
COUN'T'Y
F •L O R n R APR d 71018
Building Permit Applicati ,l
Planning and Development Services c St Lu le g Unbent
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: 2821 Jefferson Pkwy
Legal Description: san lucie plaza s/d unit one blk 59n 10'of lot 14 and all lot 15 and s 20'of lot 16
Property Tax ID#: 1428-702-1332-000-5 Lot No.14 and 15
Site Plan Name: Block No.
Project Name: reroof
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK:— _ -
reroof with new shingles
CONSTRUCTION INFORMATION M
Additional work to be ertormed under this permit—check all apply:
HVAC Gas Tank ❑Gas Piping Shutters I=1Windows/Doors
ElElectric ❑ Plumbing ❑Sprinklers ElGenerator IIIRoof4 Roof pitch
Total Sq. Ft of Construction: 2400 S Ft.of First Floor: —
Cost of Construction:$ 9k Utilities: I Sewer El Septic Building Height: 16
I
OWNER/LESSEE CONTRACTOR:
Name Evna Eliacin Name: harold otto
Address:2188 sw algiers st Company: otto built Ilc
City: PSL State: Address: 8931 sw avocado In
Zip Code: 34953 Fax: City: stuart State:fl
Phone No. Zip Code: 34997 Fax:
E-Mail: Phone No. 772-201-1908
Fill in fee simple Title Holder on next page(if different E-Mail: harold@ottobuiltllc.com
from the Owner listed above) State or County License: ccc 1327359
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
A
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:Evna Eliacin Name:harold otto
Address:2821 Jefferson Pkwy Address: 2188 sw algiers st
City: PSL State: City: stuart State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:8931 sw avocado In 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 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 your Notice of Commencement.\
6–t C_--;
Sign ture of Owner/Lessee/Contractor as Agent for Owner nature of Co` ra for/License Holder
STATE OF FLORIDASTATE OF FLORID
COUNTY OF - L(/ C'/ e COUNTY OF `r-- i' -
The for,going instru nt wa acknowledged before me The forgoing instrum nt wa acknowledged before me
this 0 day of fs, ,20/f by this k1 day of cr-I� ,20 k by
.1i f(/ get .
Name of person making statement Name of person making statement
P r y n OR Produced Identification Personally Known OR Produced Identification
Ty datification Type of Identification
Produced Produced 1'
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�� P VP`e� IIAROLD W.OTTO % V•. �41 -w� NVQ
(Si ature of Not. _• { at��frVlp�ylj@ j State of Florida `lgn, re of Notary Public-State of Florida)
•: "1:•_My Comm.Expires Jun 27,2018 }�
Commission No. ;'..t&'o;= CommIsL&a9 FF 115770 ` Commission No. c`9�,aa!,m�.,.. e �r�GRAM '�
,, Bonded Through National Notary Assn. ` s Q Q° Notary Public-State of Florida
s « LTA a• My Comm.Expires Dec 20,2018
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGF1, erd t't•4C rlatioia pryl�R� E
COUNTER REVIEW REVIEW REVIEW REVIEW RE IE` l`°- ••1 ` t1 '
DATE
RECEIVED
DATE
COMPLETED I
Rev.8/2/17