HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 1/1 112 020 Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax. (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: 4432 GREENWOOD DRIVE, FORT PIERCE:
Address: 4032 GREENWOOD DRIVE„ FORT PIERCE
Property Tax ID#: 2421-702-0018-000-3 Lot No.
Site Plan Name: CROOKS Block No.
Project Name: CROOKS
DETAILED DESCRIPTION OF WORK:
RE-ROOF:TEAR OFF MODIFIED TO BARE DECK, INSTALL 2=#75 BASE ANCHOR,INSTALL 9", 3"3 GALVAN DRIPEDGE,26 GAGE
INSTALL GAFF RUBEROID HW 170 FIR MODIFIED
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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: $ 11000 Utilities: —Sewer _Septic Building Height:
OWNERf LESSEE: CONTRACTOR:
Name NICK[ CROOKS Name:LINDOLPH CAMPBELL _
Address:4032 GREEN WOOD DRIVE Company:ABE SHULTZ CONSTRUCTION LLC
City: FORT PIERCE State:_ Address:11510 NW 20 CT
Zip Code: Fax: City: PLANTATION _State:FL
Phone No. Zip Code: 33323 Fax:
E-Mail: Phone No9648164303
Fill in fee simple Title Holder on next page (if different E-Mail LINDOLPH@HOTMAIL.COM
from the Owner listed above) State or County License CCC1 331723
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. 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 le der or an attorneybefore commencingwork or reco . No ice of Commencement.
,Le'/
Signatu caner/Lessee/Contractor as Agent for Owner Sig o n for/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF BRowARD COUNTY OFBROWARn
SWOA to(or affirmed)and subscribed before me of Swnr to(or affirmed)and subscribed before rie of
1/ Physical Presence or Online Notarization Physical Presence or Online Notarization
this 11 day of 11 2020 by this ti day of NOV 2020 by
NICKI CROOKS LINDOLPH CAMPBELL
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification oL Personally Known ` OR Produced Identification
Type of Identification Type of Identification
Produc 2"7-953-0 Prod
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Commis •n Q IExpires0511 3/2 02 3 rn.ir mission 23 33Afl45
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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