HomeMy WebLinkAboutPembrook Permit Application 10.12All APPLICABLE INFO MUST Bf COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�Lio Cc.lUJ(kQ� � (C(:>-ft. ,, t� � 0 " � • :!t;_:::;. Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce Fl 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Fence Installation
PRQPOSEO IMPROVEMENT LOCATION: ·- " �ill - "' -
Address: 5501 DELEON AVE
Property Tax ID#: 1301·614-0125·000-4 lot No. 7
Site Plan Name: Block No. 161
Project Name:
I �ETAILE�E�RIPTION � WORK: - ��:-:.:. .. ��.� .. �·=;,
Install 62' of 6' PVC fence with 1 4' gate.
New Electrical Meter Second Electrical Meter
f �iNSTR�_qlON INfQRMATION: . ... •·- 14( - ' I = , ::::::,-., ,, - ·-, - , ::\e - -
Additional work to be performed under this permit- check all that apply:
- Mechanical - Gas Tank _ Gas Piping Shutters _ Windows/Doors Pond - -
Electric _ Plumbing _ Sprinklers Generator Roof Pitch - - -
Total Sq. Ft of Construction: Sq. Ft. of first Floor:
Cost of Construction: S 2164 unnnes: Sewer _Septic Building Height: -
OWNER/LESSEE: • �· CONTRACTOR: �
Name l'YQIJIL. Mihm Name: Todd M Paroline
Address: 5501 Deleon Ave Company: Superior Fence and Rail of Brevard County Inc
City: Ft Pierce State: EL Address: 2778 N Harbor City Blvd #102
Zip Code: 34951 Fax: City: Melbourne State:�
Phone No. Zip Code: 32935 Fax: 321-638·0086
E-Mail: Phone No 321 ·636·2829
Fill in fee simple Title Holder on next page ( if different E-Mail spacecoast@superiorfenceandrail.com
from the Owner listed above) State or County License 31337
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.
SUPPLEMENTAL CONSTRUCTION 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: 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. _LUC!e Countx makes no repre�entation that Is granting a permit will authorize the 3erm1t holder to build the subject structure which rs rn con rct with any apphcable Home Owners Assoctancn rules, bylaws or an covenants that may restnct 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 Flo-ida Buildmg Codes and SI. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: ro0411 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 Count���sted ���e jobsite before the first inspection. Jfyou intend_J�_obtain fmancing, consult
with lo:>rut&r n attornev ore commencing work or recordina vcur Notice o ommencement.
� f; VJ II --2(( )M/(__ ' Signature of r/Jwner/ Lessee Cdntractor as Agent for Owner S1gnaturef)f Contractor/License Holder
STATE OF FLORIDA S±L.u.UQ STATE OF FLORIDA
� LuCAe; COUNTY OF COUNTY OF
S�rn to (or affirmed) and subscnbed before me of Sworn 10 (or affirmed) and subscribed before me of
__ Physical'""� Onhne Notanzancn 't Physical Prese9c.e or ---==--- Online Notarization
this� day of 2020 by this� day of uyf , 2020 by
:JDr:±1 � iiaB2Lu-i02 1tv\rl IV\ 1ni, "")
Name of person making statement. Name of person making statement
Personally Known '><: OR Produced Identification ___ Personally Known yJ OR Produced Identification
Type of Identification Type of toenttncancn
�educed Produced , - () ?'/ ,fl . -s . / ll.l' ClJ a (! II\ l .
�
.{) J/1 � -·11.0011.S } ./
( 1gh"at1 e of Notary P -.Jo'• , 5 SROO(S (� ur of Notary p b � i; IX)fetq �19 · Sute o! �lonlM :,.: ff c:Ml �\:on�c.c.112093
C"ommission No. 'f�. Moury Public • State of r .Clf_'Cd -..� / /i.y Co m �xc� .l,pr 5, 2011
�· �«; Co��tGGl1209i Commission No. c�,,.. et tt,ro,,1J R l tlotar; �\n.
\"frxr.�/ My Comm. [lpirt\Apr �- 2023
· 6oodM thrO!,dl tlatioiial t10Hr1 :,.;sn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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