HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,JULY 20, 2020
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Permit Number: QO — nwo
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 APPLICATION FOR:
Replace Concrete
Driveway
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Address: 5501 SEAGRAPE DRIVE, FORT PIERCE, FL 34982
Property Tax ID #: 3402-609-0046-000-6
Site Plan Name: INDIAN RIVER ESTATES - UNIT 08
Project Name: OLISKY
REMOVE AND REPOUR SECTION OF DRIVEWAY ADDING A SIDE EXTENSION
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New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
Lot No.33
Block No. 23
Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 716
Cost of Construction: $ 2,000
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
O1NN ER/LESE
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CONTRAGT4R .
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NameJUDITH OLISKY
Name:
Company:
;Address:5501 SEAGRAPE DRIVE
.City: FORT PIERCE State: _
Zip Code: 34982 Fax:
Phone No.772-342-1544
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail:hollyorb@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement, is required.
DESIGNER/ENGINEER: — Not Applicable
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MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone
State:
City:
Zip:
Phone:
'State:
FEE SIMPLE TITLEHOLDER:
-_ 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 paying twice for
improvements to your property. A -Notice of Commencement must be recorded in the public records of St..
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
With lanripr nr an'attnrnpv hpfnrp cnmmencing work or recording your Notice of Commencement.
Sig"a bre of Owner/ L ssee ontractor as Age t r Owner
Signature of Contractor/License Holder .
STAA OF FLORIDA
'COUNTY :SA, L e
STATE OF FLORIDA
COUNTY OF
OF tc-
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Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
thi�l'dayrrof. 2020 by
this day of 20_ by
CCC.e�t� 2—
NaiWe of person making statement.
Name of person making statement.
Personally Known OR Produced Identification ><_
Personally Known OR Produced Identification
Type of Identi ation
ID Cew.
Type of Identification
Produced MEL r lac C4
Pr d 4T
rel", Notary Public Stat
of Florida
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(Signature of Notary Public- State of FI igl My Commission
Expires
Notary
2 Ig natur f Public- State of Florida )
Commission No.
Commission No. (Seal)
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