HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5' pc - I Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1SS3 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: J f
Legal Description:
Property Tax lD #�`
Site Plan Name: 1 1 E Z2 D5
Project Name: c
Setbacks Front `� Back:
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Lot No._
Block No.
I mwn,Rn lerinm.. II
Total Sq. Ft of Construction:
Cost of Construction: $ JI
S Ft. of First Floor: _
Utilities.. Sewer[]Septic
Building Height:
`XiW' lIVIE55E ,.
HVAC
UGas Tank
Das Piping
Address:
Cit `
Zip Code: ?W _'7 Fax:
Phone No. (O -750-&A
L_.IShutters
❑Windows/Doors
City: Stuart State: FL
Zip Code: 34994 Fax:
Phone No. 772-408-0200
E -Mail: odonnellpennitting@gmail.com
E -Mail:
Electric
0
Plumbing
Sprinklers
InGenerator
1:1
Roof
=
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ JI
S Ft. of First Floor: _
Utilities.. Sewer[]Septic
Building Height:
`XiW' lIVIE55E ,.
CONTRACMR-
Name
Name: Michael O'Donnell
Address:
Cit `
Zip Code: ?W _'7 Fax:
Phone No. (O -750-&A
Company: O'Donnell Impact Windows
Address: 1740 NW Federal Hwy
City: Stuart State: FL
Zip Code: 34994 Fax:
Phone No. 772-408-0200
E -Mail: odonnellpennitting@gmail.com
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License: CRC1331273
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN
INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Ap cable
MORTGAGE COMPANY:
Na me: Mbheel o oennen
_ Not AMcable
Address:
Address:
City:
Zip: Phone
State:
City: sc.ert
Zip: Phone:
X State: _
FEE SIMPLE TITLE H ER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
etleraiHwy
Address::
[Add�ress:174olN
City:
Phone:
Zip:Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the' uance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit 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 attornev before
Lai
of
as Agent
ncement.
re
Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 4l( i
The for o ng Inst ent was acknowledged before me
this a of 20 ri by
Name of person Ing statement
Personally Known OR Produced Identification.
Type of Identification
The f rg ng instr nt was acknowledge before me
thisday of , 20 by
Name of person ing statement
Personally Known OR Produced Identification
Type of Identification
Produced
of
^,yam WYNN ALL
Commission No.:, ° ary Publ(' ALL of Florida Commission No.
ommisslon # FF 923070
�yjrea� `�' My Comm. Expires Sep 30, 2019
State of Florida.,..
WYNN ALLEN
0otary✓;)- State of Florida
Commission # FF 923070
122_3��z My Comm. Expires Sep 30, 201;
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED I I
COMPLETED
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