HomeMy WebLinkAboutBuilding Permit Affidavit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11123/2021 Permit Number:
LCLL
LL U, N.
L L 0 I:. L V `� �� Building Permit Application
Planning and Development Services
Building and Code RegulationDivision Commercial Residential X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: RE-ROOF
PROPOSED IMPROVEMENT LOCATION:
Address: 214 Oak Ln, Port St Lucie, FL 34952
Property Tax ID 9: 3419-501-0099-000-3 Lot No. 11
Site Plan Name: Block No. 9
Project Name: RE-ROOF DIEBOLD
DETAILED DESCRIPTION OF WORK:
RE-ROOF Q I)"C 2- 11 MOV do 1, {N 6L 5 .
► Ra Ak-R.. TAMIO WOW WN(- tT :Sy OO(i U0XkfNHeW
New Electrical Meter Second Electrical Meter (Affidavit required)
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 _SprinHers —Generator X Roof Pitch
Total Sq.Ft of Construction: 2035 Sq.Ft.of First Floor:
Cost of Construction:$ 15,000.00 Utilities: —Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name David Diebold Name: Rodrigo L. Moreira
Address: 214 Oak Ln Company: lcontracting LLC
City:
Port St Lucie State: FL Address: 6923 Narcoossee rd ste 613
_
Zip Code: 34952 Fax: City: orlando State: FL
Phone No. 772-607-3240 E- Zip Code: 32522 Fax:
Mail: Phone No 4073429242
Fill in fee simple Title Holder on next page(if different E-Mail PERMIT@ICONTRACTING.COM
from the Owner listed above) State or County License CCC1333243
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. J1
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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 conflicts with anj applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Homeowners Association and review your steed 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 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.
Signature o Contractor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF O
Swo to(or affir d}ands bsc bed be re me of Physical Presence or Online Notarization
this day of I LW-1 20 by
Name of person m ing statement.
Personally Kno OR Produced Identification 0 -L_
Type of Iden• ed
(Signs re of Not ry Public ate . - al
, ►ram A#iDMPAMA ALBA
Commission No. (9r!F'o"
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EWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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