HomeMy WebLinkAboutBuilding Permit Application 4.,
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPU,CAT:iON TO Bil ACCEPTED
Date: ermitNumber:.
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Building Permit Ap lication
Planning and Development Services
Building and Code Regulation Division
12300 Virginia Avenue,Fort Pierce FL 34982
1 Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, clic arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: =
Address: 10301 S INDIAN RIVER DR., FORT PIERCE
Legal Description: `_j S OF-1— 4- =LLof"
Property Tax ID#: 3529-701-0001-000-20 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
OVERHEAD TO UNDERGROUND CONVERSION OF UTILITIES
1 -
CONSTRUCTION INFORMATION
A1 tiona work to-be e orme under tis permit—checka a ply:
HVAC Eas Tank ❑Gas Piping S utters Q Windows/Doors
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R]Electric 0 Plumbing OSprinklers G nerator E]Roof Roof pitch
Total Sq.Ft of Construction: Sq Ft.of irst Floor: 1
Cost of Construction:$ Utilities: Sev terElSeptic Building Height:
--OWNER/LESSEE.-I - - _ CONTR A CTOR:
Name REMY B MOOREHEAD Name: C RIS RIENDEAU
Address:10301 S INDIAN RIVER DR Compan :XTREME ELECTRICAL SERVICES
City: FORT PIERCE State:FL Address: 111'01 S INDIAN RIVER DR
Zip Code: 3'4982 Fax: City: FO TPIERCE State:FL
Phone No. Zip Code 34982 Fax: 772-353-5078,
E-Mail: Phone No. 561-333-9519
Fill in feesimple Title Holder on next page(if different E-Mail: RIENDEAU@YMAIL.COM
from the Owner listed above) State or County License: EC13005450
If value of construction is$2500 or more,a RECORDED Notice of Commence ent is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMA ION
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: _Not Applicable
iName: Name:
Address:10301 S INDIAN RIVER DR.,FORT PIERCE Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDIN COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtai a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of permit.
St.Lucie County makes no representation that is granting a permit will author ze thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,byla or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review you deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree tt at I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Luc a County Amendments.
The following building permit applications are exempt from undergoing a full oncurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and iccessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commen ement may result in your paying twice for
improvements to your property.A Notice of Commencement m st be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,con It with lender or an attorney before
commencing work or recording our Notice of Commencement.
Z.,
Signature of Owner/Lessee/Contractor as Agen caner Sig ture of Contractor/License Holder
STATE OF FLORIDA STATE C F FLORIDA
'COUNTY OF �S+ Lorre COUN OF r-L_QeA P4�)
The forgoing instrument was acknowledged before me The forgo ng instrument was acknowledged before me
,this Q day of L'. �.1� 20y this�� ay of 'SCA L-(--A ,20 l by
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Name of erson making statement arae of person making statement . LL m
Personally Known OR Produced Identifi i Personal) Known OR Produced Identification 9
Type of Identificat n ♦®®p41tE��p� o®®' Type of Identificati W61
Produced ♦ N .q o® Produced I to (a4O x a
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gnat of Notary Pu is-State_ Al a �g 20205igna of Notary Publi For Ae�
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ommission No. % �eP'FF 99198 °•o Xommissi n No.°�C� (�5�5�Z (Seal) �� -
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REVIEWS FRONT ZONING f�S OISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17