HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
Planning and Development Services
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:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
Lot No.
Block No.
Back: Right Side: Left Side:
-T��ffct�J�–v�- 1� G�'�'.�rd�t�t �u�"`ers UJL�
1d�c�r�-4—
HVAC
11 Electric
F]Plumbing F]Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 0, 110
I ']Shutters
[]Generator
Sq. Ft. of First Floor:
Utilities: []SewerF—]Septic
F]Windows/Doors
0 Roof Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name vVI,
Name: Michael O'Donnell
Address: e. dy— Q v �),ir I LAJ'�_
Company: O'Donnell Impact Windows
City: u, U) .3VI Y4 . State: Ndo
I—Address: 1740 NW Federal Hwy
City: Stuart State: FL
Zip Code: Fax:
Phone No. I 9
Zip Code: 34994 Fax:
E -Mail:
Phone No. 772-408-0200
Fill in fee simple Title Holder on next page ( if different
E -Mail: odonnelipermitting@gmaii.com
State or County License: CRC1 331273
from the Owner listed above)
it value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
N a m e: Michael O'Donnell
Address:
Address:
City: State:
Zip: Phone
City: Stuart State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address: 1740 NW Federal Hwy
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
-ommencing worK or recording Your Notice of Commencement.
r"
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder h
STATE OF FLORIDAc i / ' r STATE OF FLORIDA
COUNTY OF , ' COUNTY OF
0 dig L''5
The ak,
ng instr ent was ack owledged before me
this of f 20 by
f�£ i, t Ct..,
Name of person ing statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signatur fNotaryPublic--Stat*omw
P' b '�.p,r�,/� WYNN ALLEN
Commission No FJ'1�rY Publ(6ete of Florida
•�Commission # FF 923070
' '`OF My Comm. Expires Sep 30, 2019
The for rnstr ent was ack owledged before me
this f ° day of 20[by
OAJalyu_� U , i, JJ_JP,,
C.
Name of person ing statement
Personally Known OR Produced Identification
Type of Identification
Produced
Y,11fA,R
(Sign at of Notary Public- State of Florida.)
1 zWYNN ALLEN
Commission No. AI .04otary p- State of Florida
° « _ Commission # FF 923070
My Comm. Expires Sep 30, 2019
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DATE
RECEIVED
COMPLETED
Rev. 8/2/17