HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
also
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 x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED]M PROVEM ENT LOCATION:
Address: 4 Jacaranda Lane
Legal Description: ST LUCIE GARDENS 26 36 40 BLKS 1 AND 2 LYG ELY OF US#1 R1W-LESS RD RSlW AND LESS AS IN ORS
2535-2430:2544-2463:2547-1528:2554-1237:2563-2398,2417:2570-2920:2625-1174:2644-2626:
Property Tax ID#: 3414-501-1701-000-9 Lot No.
Site Plan Name: Block No.
Project Name: DRISCOLL
Setbacks Front ' Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
RE ROOFAS��^G'`� 5(�;•��{ T�N�11,,e (�- O c(10. .0
30 411 ASfi0t
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all In
appy:
HVAC Gas Tank ❑Gas Piping _Shutters I]Windows/Doors
Electric 0 Plumbing OSprinklers E Generator R] Roof Roof pitch
Total Sq. Ft of Construction: 1450 S . Ft.of First Floor: 1450
Cost of Construction:$ 4500 Utilities:nSewer Septic Building Height: 9
OWNERAESSEE: --CONTRACTOR:
Name V100A 61&lollerr /1I�i Ko ra�SAVill Name: RAFAEL A PAIVA
Addresl3: 4 \kCIO fV,4 � L614e l Company: AMERICAN ONE ROOFING CONSTRUCTION AND RESTORATION INC
City: 1 bry ftLuGIP� State: �L Address: 10694 PELICAN DR
Zip Code: 3`(95.4 Fax: —(0- City: WELLINGTON State:FL
Phone No. 77A- LE 7- a6127 Zip Code: 33414 Fax:
E-Mail: Phone No. 561-701-5358
Fill in fee simple Title Holder on next page(if different E-Mail: RPAIVA AMERICANONEROOFING.COM
from the Owner listed above) State or County License: CCC 1330738 .
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:MFAEL A PAIVA
Add rens:4 Jacaranda Lane Address:
City: State: City: WELLINGTON State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address-10694 PELICAN DR 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 of the granting of this requested permit, I do hereby agree that 1 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.
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lyi-4 � � J
fiinatuie of Owner/Lessee tractor as AgeW for Owner Signature of Contr c Lic se Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF S'�-� U(',4 COUNTY OF
The forgoing instru ent was acknowledged fore me The forgoing ins ument was acknowledged before me
this ' day of 20 / by // thi ` day of 20q by
�c>�.n f�YiScol( � �S�eh'Y l�fl�o�i'cld'�Ili(I�
' �fLa����f perso aking statement N-WP of person making statement
Personally Kno n OR Produced Identification Personally Known OR Produced Identification
l�}p ication T pe of Identification
Produced duced Z L�
�� IRENE,HI
f ?� sNot�ry Pub11C ;Stib ohF10r ai;
992191;.2
(Signature of Notary Public to ignature of Notary Public-State of Florida7T
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Commission NO. T -(� �^ (Seal) Commission No. .�..�""'�'�•.
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Notary Pubflc-State of Florida
My Comm.Expires Dec 20,2018
F. 1 77249
REVIEWS FRONT ZONING SUPERVISOR PLANS VEG ' TI Bu r 1 LE'IOn, nIVIA(NG, OVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVtd'V.
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17