HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFQ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �a� 1 , '}b Permit Number:
Mn --
PERMIT
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Lucie
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resi APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.PROPOSED iMP 'bVEMENT LOCATION: _
Address: 10307 S indian River Drive
Legal Description:
Property Tax ID#: "Jj1-lc��~ doily' 4�0'� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
:DETAILED DESCRIPTION`rOF WORK
Wire in plugs for hirricane shutter in carport garage wire in for a cieling fan cieling in carport garage
CONSTRIJCTION:INFORIVIAI ION.
Additional work toe e orme under this permit—check a appy:
HVAC 13 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric ElPlumbing ❑Sprinklers 1:1Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 900.00 dollars UtilitiesSewer Septic Building Height:
OWNER%LESS'EE:}, CONTRACTOR:
NameJesse philips Name: RobertT Payuk
Address:10307 S Indian River Drive Company: Payuk Electric LLC
City: Ft Pierce State:171 Address: 2501 SE Calusa ave
Zip Code: 34982 Fax: City: Port Saint Lucie State:FI
Phone No.1-812-327-2485 Zip Code: 34952 Fax: 772-35-1637
E-Mail:jeephill@gmail.com Phone No. 772-337-4197
Fill in fee simple Title Holder on next page(if different E-Mail: bobtom12@bellsouth.net
from the Owner listed above) State or County License: Ec13001275
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALC NSTRU 'TION•LIEN-LAW-,INFORMATION.
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:
Address:2501 SECalusaave 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 tolour property.A Notice of Commencement must be recorded and posted on the jobsite
before the first i 'pection. If y ntend to obtain financing, consult w'th lender or an att nay before
commencin ork or recon, our Notice of Commencement.
i
Si nature /Lessee/C, ractorasAgent for Owner Signatu Cora or/ cense Holder
STATE OF FLO DA STAT F FLOR A
COUNTY OF L COUNTY OF L )CA e
The forgoing instr ment was acknowle ftbefore me The forgoing instrument was acknowledged before me
this V% day of 20_ by this day of {�t c 20by
iy_1 C\0-"r--If f�*'3
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced r'Lt) Produced F L D L
(Signature of Notary ublic-State of Florida) gnature of No ®ly >�
SEAN
MpR�E o q MMI881 IJIf
Commission No. �"�7u e� AGN GG Co mission No. ��, )§ i
:i:A''• M�P��Qecem V�de 'tare �1::;o?i..'�'�'° Woad"WBIi►1�(�lW�ti fl!$§is
FX Notary P ,,.,,,,.+"'
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REVIEWS FRONT SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17