HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�0 1�0L11 E
qL1
L .,. Building Permlit Application
Planning and Development Services o
Building and Cade Regulation Division Commercial_ _ Residential YN
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: fence Installation
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: � ' 015;� Lot No.
Site Plan Name: i)rt yoga _ Block No.
Project Name: N U ur Ire CND
D
DETAIILED DESCRIPTION OF WORK:
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: $ T. ) Utilities: .-- Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
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Name_6XV1 11 V
Name: Todd M Paroline
Address: I�—
Company: Superior Fence and Rail of Brevard County Inc
Address: 2778 N Harbor City Blvd 4102
City: , T e (� State:
City: Melbourne State: FL
Zip Code: 32935 Fax: 321-638-0086
Zip Code:4o, 5-1 Fax:.
Phone No. ! a-T7.� I
f
E Mail: 5G(f' "()Cebell i'_T
Phone No321 636 ?_829
Fill in flee simple Title Holder on next page ( if different
E-Mail spacecoastCa)superiorfenceandrail.com
State or County License 31337
from the Owner listed above)
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 poste pn the jobsite before the first inspection. If you intend to obtain financing, consult
with lender att re before commencing work or recordi ur N ce of Commencement.
Signature of O ner/ Lessee ontractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA I , ,
COUNTY OF-1-!/l��
STATE OF FLORIDA a
COUNTY OF LLA�iI�J
_
Sw rn to (or affirmed) and subscribed before me of
ysical Pres nce or Online Notarizatljw
S�°�rn to (or affirmed) and subscribed before me of
7� ysical Presen e or Online Notarization
this day of i "M by Z-1
this day of by
@2
Todd M Paroline
Todd M Paroline
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
P duced
Produced
( a ure of Notary Publfctate of orida)
atu e of No r P b i . t e f
Commission No. ST QR(?C �S
;: STEPHANIE BROOKS
: o . -
Commission No. _ • r �: Notar Public - St(�jlorida
Notary Public State of ^ ; nod
• '�° Commission N GG V ZO"
*• o Commission GG 312093
'? of My Comm. Expires Apr 5, 2023
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DATE
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RECEIVED
DATE
COMPLETED
STEPHANIE BROOKS
Notary Public - State of F.onca
Commission ; GG 3120A3
Bonded through National Notary Assn.