HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IN�,MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_ J Ia 0+ Permit Number:
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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: SCA-f <"k
PROPOSE).?IMPR'OVEMENT�L'OC`ATION i
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Address: 10301 S INDIAN RIVER DR., FT PIERCE, FL 34950
Property Tax ID#: 3529-701-0001-000-2 Lot No.
Site Plan Name: Block No.
Project Name:
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CQNSTRUCTION INFORMATIONM ,
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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: -Sq.Ft.of First Floor:
Cost of Construction: ,� �� Utilities: —Sewer .__.,.Septic Building Height:
NameREMY B&BLAKE E MOOREHEAD Name:CHRIS RIENDEAU
Address:10301 S INDIAN RIVER DR Company:XTREME ELECTRICAL SERVICES INC
City: FORT PIERCE State:_ Address:11101 S INDIAN RIVER DR
Zip Code: 34950 Fax: City: FORT PIERCE State:FL
Phone No. Zip Code: 34982 Fax: 772-801-1440
E-Mail: Phone No 561-333-9519
Fill in fee simple Title Holder on next page(if different E-MailARIENDEAU@YMAIL.COM
from the Owner listed above) State or County License EC1 3005450
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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ENTAC`CQNSTRUCTION LIEN CAVI( tNFtJRMATION ;�'>
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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: 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.
1 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,wails,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
WffH yOUjR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signa re of ContractorJLicense Holder
STATE OF FLO I STATE OF FLORIDA� / Q r
COUNTY OF � �tv1 ��`+ COUNTY OF
The forgoing instrgUni nt was acknowledged before me The for ping instrument was acknowledged before me
this I S ay of Y"104' ,20ag by this /9+ da of 20—M by
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Name of perso7making statement. Name of person making statement.
Personally Known X OR Produced Identification Personally Known 1OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Nota (Signature of Notary Pub of Nc4n�ya>�uniic State as Florida
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Notary AubGc Smut of F�!atats b s �� Tina L Lattiinn�,
Commission No. Tina L La@a!� Commission No. �® aw �y� -fit2oGG ss0aa�
'V'� �Q y Commission ti 6606ci y Expinss OS11 24
eil Expires 06/1612024
14 Aworry
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW I REVIEW REVIEW REVIEW
DATE
RECEIVED'
DATE
COMPLETED
Rev.2/7/19