HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �( _
Date: ' ��'f Permit Number:
RECEIVED
APR 12 20'8 J
Building Permit Application ST, Lucie count ,
Planning and Development Services Y Permitting
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: C
Address: 13994 Encantardo Cir., Fort Pierce, FL, 34951
Legal Description:
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Property Tax ID#: Llk, ,
I �-�l'�/�U'}[" &3 ( 17-7 0-3 Lot No.
Site Plan Name: Block No.
Project Name: P168 Bruce Pank
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work toe er orme under this permit—check a app y:
HVAC F] Gas Tank 7Gas Piping Shutters ❑Windows/Door
11 Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 00 S . Ft. of First Floor:
Cost of Construction: $ K J Utilities: Sewer _Septic Building Height: 5'f
OWNER/LESSEE: CONTRACTOR:
Name Bruce Pank Name: Chris Dutruch
Address: 13994 Encantardo Cir. Company: My Affordable Roof(MAC MAR, LLC)
City: Fort Pierce State:FL Address: 1585 Kennesaw Dr.
Zip Code: 34951 Fax: City: Clermont State: FL
Phone No.(772) 323-5304 Zip Code: 34711 Fax: 772-905-8694
E-Mail: Phone No. 772-206-3344
Fill in fee simple Title Holder on next page ( if different E-Mail: `Mendell@myaffordableroof.com
from the Owner listed above) State or County License: CCC1331305
Le 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: 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 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF COUNTY OF Ol�� STATE OF FLO
COUNTY OF
The for ing instru nt w s a cnowledged before me The forgoing instru ent as acknowledged before me
this ay of / 20�y this-1.0,day of 20_a by
Name of perVOR
aking statement Name of per ma ing statement
Personally Known Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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.BRITTAIN """��. THOMASINA I.BRITTAIN
Notary Publicire ,`�� P�a� _
Commission No. i� Commisslo S 240819Florida Commissi .�Wj�,�: N Commissotary ion#�tFF 2ate 40819
MY Comm.Expires Jun 16,2019 % My Comm.Expires Jun 16,20NationalNot As :
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17