HomeMy WebLinkAboutBuilding Permit Application a
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: d Permit Number:
• . - . -
RECEIVED
Building Permit Application
Planning and Development Services APR 19 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Permitting Department
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re id6ttid1Q* 1'L5 County, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED.IMPROVEMENT LOCATION:
Address: 6101 Deleon Ave.
Legal Description: LAKEWOOD PARK-UNIT 10-BLK 129 LOT 7(MAP 13/01S)(OR 395-770: 1473-123)
Property Tax ID#: 1301-612-0255-000-8 Lot No.
Site Plan Name: Block No.
Project Name: Eichelberger Residence
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Re-Roof aj (51 bp-e- 42` �0► LCl,�S �)b TSH`
CONSTRUCTION INFORMATION:
Additional work toeperformedunder this permit—check a appy:
❑HVAC LJ(Gas Tank Gas Piping Shutters Windows Doors
❑Electric 0 Plumbing ❑Sprinklers OGenerator Roof "I Roof pitch
Total Sq. Ft of Construction: ]14D 16,788 S . Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer El Septic Building Height:
OWNER/LESSEE: "` CONTRACTOR:
Name Caryn Eichelberger Name: Edward Campany
Address:6101 Deleon Ave. Company: Campany Roof Maintenance Roofing Division, LLC
City: Fort Pierce State:FL Address: 917 28th St.
Zip Code: 34951 Fax: City: West Palm Beach_ State:FL
Phone No.-12- 53B 23 tD Zip Code: 33407 Fax: (561)863-1722
E-Mail: Phone No. (561)863-6550
Fill in fee simple Title Holder on next page(if different E-Mail: Kaylee.brodock@crmrd.com
I
from the Owner listed above) State or County License: CCC1330613
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU-PPLEMENTAL CONSTRUCTION,LI;EN LAW INF,,ORMATION„
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 County makes norepresentation 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.
Signature wner/Lessee/contraittor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �� STATE OF FLORL4
COUNTY OF ��,,II (Y� COUNTY OF �,�,411'1. C(C.,h
The fo oing inst me as acknowledged before me The f oing instru ent wa acknowledg before me
this day of 20 j� by this day ofJ 20i by
-eaw yikffVf(J Oou Jy�
Nanie of person g state ent Name of person��king tatement
Personally Known OR Produced Identification Personally Known L/ OR Produced entification
Type of Identification Type of Identification
Produced Produced
�nv 0 hL &Ubbl� 6J 1 ILL
(Signatur f Notary Public-State of Florida) (Signatur f Notary Public-State of Florida)
Commission No. �C 'mal) KAYLEEBRODOCKCommission No.v� I r°� �Pu al) XAFF2 gEEB# K
commission#FF 20461111
e Expires Much 1,201 �q e� Expires March 1, 1
KAYLEE BRODOCK -.' �� 6 'FoF ttio� Baided 7hru Budget Notary
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�� ch1- OWNING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
MfPRMWIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17