HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S!1 U Permit Numtsi&�n
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Building Permit ApplicatioMAY 012018
Planning and Development Services Dep 8 rtm ent
Building and Code Regulation Division itting FL
2300 Virginia Avenue,Fort Pierce FL 34982 r j e Iro u my
Phone: (772)462-1553 Fax: (772)462-1578 Commercial 7C
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PR0 OSED:.I;M,PROVEMENT LOCATION
Address: 7001 S Indian River Drive, Fort Pierce, FL 34982
Legal Description: OLMSTEAD PLACE S/D LOT 6 (OR 3893-649)
Property Tax ID#: 3412-502-0007-000-4 Lot No.6
Site Plan Name: Diane Phillips Block No.
Project Name: Diane Phillips
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
//V.S'T�LL�}TionJ DF f1oetelC19N&- .550 W-L)2S:
CONSTRUCTION:I N FORMATION
Additional work toe nnprtormed under this permit-check all apply:
❑HVAC Gas Tank Gas Piping Windows/Doors
11 — ❑ p g Shutters ❑
Electric ❑Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 3,902.77 Utilities:Sewer Septic Building Height:
OWNER/LESSEE. CONTRACTOR:`
Y
Name Diane Phillips Name: Miriam Van Tassel
Address:7001 S Indian River Drive Company: DVT Hurricane Shutters, Inc.
City: Fort Pierce State:FL Address: 3100 N Kings Hwy
Zip Code: 34982 Fax: City: Fort Pierce State:fl
Phone No.912-658-0508 Zip Code: 34951 Fax: 772-794-1590
E-Mail:tinaacord890@comcast.net Phone No. 772-794-1581
Fill in fee simple Title Holder on next page(if different E-Mail: dvthurricaneshuttersinc@hotmail.com
from the Owner listed above) State or County License: 24394
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATI"ON:.
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:
Ad d rens: 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 thepermit 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 caner/Lessee/Contrac or as Agent for Owner Signature Contractor/License Holder
A
STATE OF FLORID ; STATE OF FLORID
COUNTY OF COUNTY OF
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The forgoing instrument was acknowledged TOPS'"me The forgoing instrument was acknowledge 4_oyn
this day of 20 this+__day of . 20 . w c
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Name of erson making statement d Nam son making statement F a.r.
Personally K n OR Produced Iden im 0 Personally own OR Produced Iden tal.
Type of Id ion §o T= Type of Ide ation o
Produced o Produced tON
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(Signature of Nota ublic-State of Florida) (Signature of Vy Public-State of Fforid
Commission No. (Seal) Commission No. (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