HomeMy WebLinkAboutPermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Q 6 0 lil u uCA� 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: John Roland, Jr
PROPOSED IMPROVEMENT LOCATION.
Address: 10751 S Ocean Drive A9, Jensen Beach, FL 34957
Property Tax ID #: 4511-311-0013 000 0 Lot No. A9
Site Plan Name: Block No.
Project Name: John Roland, Jr
DETAILED DESCRIPTION OF WORK.
I (t:4a 11 I I m �Xt.CA Eck' ve- � l � � � aczc � � i V�)CVC.)s
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 o� Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ { �`- Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name John Roland
Name: Scott Berman
Address: 10751 S Ocean Drive A9
Company: Florida Window & Door
City: Jensen Beach State: _
Zip Code: 34957 Fax:
Phone No. 908461-2633
Address: 1125 N Dixie Highway
City: Lake Worth State: FL
Zip Code: 33460 Fax:
Phone No 561-340-4300
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail howard@floridawindowanddoor.com
from the Owner listed above)
State or County License 28576
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:
Name:
— Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
_
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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.
t. Lucie County makes no representation that is granting a permit will authorize the permit holder'to build tyre 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.
Inconsideration 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 lender or an attornev before commencing work or recording your Notice of Commencement.
Sign
/
STATE OF FLORIDA
COUNTY OF
actor as Agent for Owner � Signature of Contractor/License Holder
Swoto (or affirmed) and subscribed before me of
V Phx�'ical Pre ence or Online Notarization
this L day of 202� by
John Roland, Jr., Owner
�I�^�� Of p�rs;;n rnskira �t?felrent,
Personal lykKnown�� OR Produced Identification
Type ctf Idenxificatifj� ;%
Produdedt'
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(�tg6qture�of Nc�tar�Putqlio4 State of Florida )
Corr;r>irk4s o Nlo. ` '�l `� l (Seal)
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
STATE OF FLORIDA
COUNTY OF Pa�m6eaoh
Sw rn to (or affirmed) and subscribed before me of
Ph�ical Presence or Online Notarization
this day of �� �/ , 202t by
Scoll Berman
Name of ner•;rr, making statement.
Personally Known x
Type of Identification
Produced
Commission
OR Produced Identification
Public -
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
COUNTER
REVIEW
I REVIEW
I REVIEW
, REVIEW
o�Mr °r� Notary Public State of Florid+
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_ o` y Co mission GG 218215
otw� Expires 05/15/2022
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