HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR AP .CATION TO BE ACCEPTED
Date: (' ' a I Permit Number:
JAN 11� .1021
Permitting Dew6
p st. Lucie 66.i; ff Y
-. Building Permit Application
Planning and Development Services _
Building and Code Regulation Division Commercial Residentialy
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: WJ LL- RI'°A" P
PROPOSED IMPROVEMENT LOCATION:
Address: 9309 S Indian River Drive
PropertyTax ID #: 3519-441-0002-000-1 Sec/Town/Range: 19/36S/41E Lot No.
Site Plan Name: n/a Block No.
Project Name: n/a
DETAILED DESCRIPTION OF WORK:
Exterior wall repair. Please see attached document. ,1. n ro r 06 1 j VI/
r,l 1-n K w '14'1, S+14 L-t-o .
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: ¢ 300 (repair area) Sq. Ft. of First Floor: 300 +1- (repair area)
Cost of Construction: $ 5,000 +/- Utilities: —Sewer _ Septic Building Height: 141 +/-
OWNER/LESSEE:
CONTRACTOR:
Name Mark and Lawrence Fick
Name:
Address: 13931 Amber Lane
Company:
City: Montgomery State: TX
Address:
Zip Code: 77316 Fax:
City: State:
Phone No. 936-443-3403
Zip Code: Fax:
E-Mail: twinoaksLBF@gmail.com
Phone No
E-Mail
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
If value of construction is Z500 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: X Not Applicable
Name: Richard E Atwood
Name:
Address: 5212 Hickory Dr
City: Fort Pierce State: FL
Address:
City: State:
Zip:32982 Phone 407-304-0264
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
BONDING COMPANY: X 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
impr,pvementso youf property. A Notice of Commencement must be recorded in the public records of St.
i ou
a pos eo on the jobsite before the
tirst inspection. It you intend to obtain tinancing, consult
Pg�u I nd
or attolmey before commencing work
or recording our Notice of Commencement.
Si nature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA -
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sw5p to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
P ysical Pre ce or Online Notarization
this _4 day by
Physical Presence or Online Notarization
this day 2020 by
of 1?_92U =-�L j
_ of ,
// iv 61 rl J�
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 Identification
Produced I C.
i
Produced
(Signature of Notary " blip,
i'i (Signature of Notary Public- State of Florida )
;=o<P?`•".�s�;, AUDREYB.HUMPHREY
= MY COwhifION #I GG 300817
Commission No. `+:
Commission No. (Seal)
EXPIRES: March 6, 2023
FOF F�° Bonded Thru Notary Puhlie Underwit . .
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