HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: 71�Q-q � n Permit Number:
RECEIt r_D SEP 2 6 2017
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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 x
PERMIT APPLICATION FOR: Roof - �-'� \.<
PROPOSED IMPROVEMENT LOCATION: fr
Address:
Legal Description: 8036 Plantation Lakes Drive Port St. Lucie, FL 34986 Reserve Plantation-Phase IIA-Lot 30
(MAP 33/28N) (OR 3329-1320; 3541-1730)
Property Tax ID#: 3321-803-0036-000-1 Lot No.30
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Sider Left Side:
DETAIL SC ED DERIPTION O'F WORK:_,",
Remove existing tile & Replace w/ New Tile
CONSTRUCTION INFORMATION: . _ =;
Additional work to a er orme under this permit—check a apply:
E1HVAC E]Gas Tank Gas Piping _Shutters Windows Doors
11 Electric ❑ Plumbing Sprinklers E Generator Z RI of 8/12, Roof pitch
Total Sq. Ft of Construction: r f S . Ft.of First Floor:
Cost of Construction:$ `�`"(,5a5. Utilities.
�Sewer Septic Building Height:
OWN ER/LESSEE: x°°CONTRACTOR:
Name N/A 701f ' W6 D�5� Name: `� S
Address:__ _J23f'p F�k/T7,,��/.�/� C, i -e /' Company: Alliance Group j
City: .,, -I:� State:FL Address: sl � NyJ YYIfXC Gt i t I�..pC. l��
Zip Code: Fax: City1(2&!' -V.(,1,.6e, I State:FL
Phone No. Zip Code: 34986 Fax: 772-492-8008
E-Mail: Phone No. 772-492-8006
Fill in fee simple Title Holder on next page(if different E-Mail: dbeggs@gmail.com ;I
from the Owner listed above) State or County License: C=b30918
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CbNSTRUCTION LIEN LAW INFORMATION':,
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:NSA Name:N/A
Address: Address:
City: State: City: S,dte:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name:N/A Name:N/A
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the workiland 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 bl ild 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an!attorney before
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of C n a for/License Holder
STATE OF FLORIDA STATE OF FLO"?A�Q
COUNTY OF COUNTY OF LIC
The forgoing instrument was acknowledged before me The f rg•'ng ins*' ewa ackn Iwledg d before me
this day of 20_ by this ay of 20� by
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Name of person making statement Name of person maki tement
Personally Known OR Produced Identification Personally K wn X OR Produced Identification
Type of Identification Type of Id ification
Produced Produce
(Signature of Notary Public-State of Florida) X19krture of Notary Publi oa pp_V4 ort a L.RYC9CMA
Commission No. (Seal) Commission No. = :'€ MY_WMJAISSICN#FF1455 3
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EXPIRES July 27, 2018
(407)396-0153 F1Afld4Nc1inrySorv1c0.c0m
I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE P"ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW rcEVIEW
DATE
RECEIVED
DATE !
COMPLETED
Rev.8/2/17
1 I
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
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:
I
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signat0e of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA C� STATE OF FLORIDA �� r
COUNTY OF � (� i rl COUNTY OF L (
The aging instr ent was acknowledged before me The rg ing instr m was ck�n Iwledged before me
this Wring
of 20_U by this , of C-a 2Ql 7 by
e Seq
Name of persgn making stateme Name of pers9n making sta nt
Personally Known 1V OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of Notary Public-State of Florida (Signature of Notary P ir, . to o F orlddaa�
os' av ADAM L RYCKMAN
Commission No. ;_°: "°8�•.• ADAM(�e jYCKMAN Commission No. _ =I MY CO II ffON#FF145513
r € MY COMMISSION#FF145513 �1
EXPIRES July 27, 2018
.; 2018
Y •..i.i.•..
EXPIRES July 27 (407)390.015� FlorldnNotaryservice.com
W)3�38-015 Flarl F1
REVIEWS F4 ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17 i
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