HomeMy WebLinkAboutBUILDING PERMIT APPLICATION�oeA-D
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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_
I PERMIT TYPE: j
PROPOSED IMPROV EMENTION:
Address: > 1 ��y�ltS�?�� kJyt_�2
Property Tax ID #: %)L-1 bLA -TQ9 - 0a2,1--('1{5(3 - 5 Lot No.
Site Plan Name: V(-,,A �,.`9 Block No.
Project Name:
FIDETAILED DESCRIPTION OF WORK:
onp_ 17, ��r.J CuLp i�mJ✓T� �1��11,vQ��
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1C) �> Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name t ; �� , ��(',.�1 �L�t Name: 3AMES E REYNOLDS
' J �. Company: CORAD INC
Address:
City: �-c�r tate:� j Address: 2771 VISTA PKWY STE F11
Zip Code: cl�� Fax: City: 1/1/EST PALM BEACH State: FL
Phone No.-7-7 ' �1 5" �`>� 7_ip Code: 33411 Fax: 561-771-0049
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E-Mail: Phone No 561-771-0047
Fill in fee simple Title Holder on next page ( if different E-Mail REBECCA@PERMITGROUPFL.COM
from the Owner listed above) State or County License CGC 054348
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
jName:
DESIGN FR/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address: Address:
City: State: City: State:
Zip: Phone I 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signat a of Owner/ Lessee/Contract as Agent for Owner Signature o ontractor/License Holder
i
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY OF PALM BEACH
I
The forgoing instrurrAnt was acknowledged before me The forgoing instru��y�nt was acknowledged before me i
t�l L— 20Z� by
this � day of _ / _ 20_ by this � day of
JAMES E REYNOLDS JAMES E REYNOLDS
Name of person making statement i
Name of person making statement.
Personally Known identification I Personally Known OR Produced Identification
Type of Identification Type of Id ntific n
v� Notary Public State of Florida I Nb Public State of Florida
F Produce
Produced E Stephens a CCa E Stephens
My Commission GG 958848 ry My Commission GG 956848 j
Expires 02/162024 �aR Expires 02/162024
I (Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Commission No. (Seal) Commission No. (Seal)
MANGROVE
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
i COMPLETED
Rev.