HomeMy WebLinkAboutBuilding Permit Application 1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED F ,�J1 c�
Date: � �� )
Permit Number: I; Ota
" - 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 TYPE: RE ROOF SHINGLE
PROPOSED IMPROVEMENT LOCATION' , ..e
Address: 5003 EL NUEVA AVE
Property Tax ID#: 1431 703 0059 000 3 Lot No.17
Site Plan Name: HARMONY HEIGHTS ADDN NO3 Block No. C
Project Name:
DETAILED DESCRIPTION`0;F WORK
RE ROOF SHINGLE ' o
7 11 S7'cE A/1 /✓P L✓ �/1 leg G/! J U ACj F
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator -,-Roof Pitch
Total Sq. Ft of Construction: Z t/Ob Sq. Ft.of First Floor:�X07
Cost of Construction:$ 49, 5D d Utilities: Ysewer _Septic Building Height: /ter
OWNER/LESSEE ` .'` CONTR '(-TOR!'.
Name FAZAL MOHAMMED, MEHRUNNISA KAPADIA Name:TODD ADDERLY
Address:758 BENT CREEK DRIVE Company:ADDERLY DEVELOPMENT INC
City: FORT PIERCE State:_ Address:5079 N DIXIE HWY#258
Zip Code: 34947 Fax: City: OAKLAND PARK State:FL
Phone No. Zip Code: 3333 Fax:
E-Mail: Phone No 954 445 4078
Fill in fee simple Title Holder on next page(if different E-Mail ADDERLYDEV@YAHOO.COM
from the Owner listed above) State or County License CCC 1327886
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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:SUPP,LE(VIENTACCONSTRUCTION LIEN LAW MATIONJ.
INFOR
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone I Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OFC MMENCEMENT."
Xl 11R�1rJvl+tirS'a.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractortiicense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF BROWARD COUNTY OF BROWARD
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 10/1/19 20_ by this day of 10/1/19 20_ by
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 IdentificationL�
Produced Produced
S®�
(Signature of Notary Public-State of Florida) (Signature of Notary Publi f Florid$�� FF927 4
4,v,• Ca OMMISg10�
Com is Y` GAIL RORINSOI�eal) Commission No. +`- MY C OctobeC 14.20'g
MY COMMISSION#FF927240 -4;0.
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•$5
EXPIRISSOdQber 14 2019 598.0'
007)398-0' 3 Flondallola Sorvlce.coro
REVI SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
�-ev.2/7/19