HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEDIMPROVEMENTLOCATION:
Address:
Legal Description:
Property Tax lD#: -/N-1) r7r, -6)66 Lot No.- --b 17
Site Plan Name: Block No.
Project Name:_
Setbacks Front V---" . Back: Right Side: Left Side:
CONSTRUCTION INFORMATION: I
Additional work tobe performed under this permit —check all that apply:
11HVAC 11 Gas Tank ❑Gas Piping ]Shutters ZWindows/Doors
Fl
11 Electric Plumbing Sprinklers 11 Generator El Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: 11 Sewer Septic
Building Height:
OWNERAPS EE:
CONTRACTOR:
Name 't 'VA 76 Atid) V\ lCt&I Y -WA
Name: Michael O'Donnell
Address: 1Company:
O'Donnell Impact Windows
City: Pt),State: EL
Address: 1740 NW Federal Hwy
Zip Code: a ifCi'o Lo Fax:
City: Stuart State: FL
V _q65-44
Phone No. 711
Zip Code: 34994 Fax:
E -Mail:
Phone No. 772-408-0200
Fill in fee simple Title Holder on next page ( if different
E -Mail: odonnellpermifting@gmail.com
State or County License: CRC:1 331273
from the Owner listed above)
it value of construction is 5Z500 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: Sleart State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address: 1740 NW Federal Hwy
Address:
City:
City:
Zip: Phone:
Zip: Phone:
UWNtK/ 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 recordin our Notice of Commencement.
_ --4,
Signature of Owner Lessee Contractor as Agent
n lj s
g / / t for Owner igs afore of Contractor/License Holder
STATE OF FLORIDA ; STATE OF FLORIDA T
COUNTY OF ',� �'� COUNTY OF
The f r in instr� ent was acknowledged efore me The fo g instrument was acknowledged before me
this day of LY-, 20 by this gay of � � � 20 11 by
c
NVI A A1
Name of person mg statement Name of personwr9king statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signator f Notary Public-���S��taaate:of-JQcl6.d ., (Signat of Notary Public -,State of Florida)
fP 1nP„ rl NN ALLENWYNN ALLEN
Commission No. �p ry Publ(Seiftte of Florida Commission No. (r� 7 "> ' 1 � L�Jotary"O- State of Florida
ommisslon # FF 923070: Commission # FF 923070
+w��,FOFF�O�cOc` My Comm. Expires Sep 30, 2019 �''•;koFF�:�'` My Comm. Expires Sep 30, 2019
U010-11 National Notaq AssnPullT
REVIEWS FRONT ZONING SUPERVI OR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17