HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE __:OPLETED FOR APPLICATION TO BE ACM-i .�J p
Date: SCANNED Permit Number: I
y s :T Lude Counter
Building Permit Application
Planning and Development Services MAR 09 2019
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting
Lude Counts
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION i w M
Address: 12001 Orange Ave Fort Pierce, FL 34945
LegalDescription: 935 39 BEG AT NE OCR OF W 1/2 OF E 1/2 OF NW 1/4 OF SW 1/4 RUN W 165 FT, TH S 395, 4FT, TH E 165 FT.
TH N 395.4 FT TO POB-LESS ORANGE AV R/W AS IN PB 22-16- (1.49 AC) (OR 550-1770 )
Property Tax ID #: 2309-322-0002-000-7
Site Plan Name: N/A
Project Name: N/A
Setbacks Front Back:
DETAILED DESCRIPTION -OF WORK:
Remove Shingles, INSTALL 5-V CRIMP
Right Side:
Left Side:
Lot No._
Block No.
CONSTRUCTION INFORMATION
a
Additional work to be nertormed under this permit — check
all
apply:
�HVAC
Gas Tank
E] Gas Piping
_
Shutters
❑ Windows/Doors
Electric ❑ Plumbing
OSprinklers
Generator
Roof 4�12 Roof pitch
Total Sq. Ft of Construction: 3,000
S . Ft. of First Floor:
Cost of Construction: $ 16,375
Utilities:
Sewer
[]Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name THELMA M BROOKS
Name: WILLAIM LASKY JR.
Company: ATLANTIC ROOFING II OF VERO BEACH FL INC.
Address: 4310 45TH ST
Address: 12001 ORANGE AVE
City: FORT PIERCE State: FL
Zip Code: 34945 Fax:
Phone No.
City: VERO BEACH State: FL
Zip Code: 32967 Fax: 772-257-5740
Phone No. 772-492-8493
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: wiatr@aol.com
State or County License: CCC1326188
11 vdiue u1 LonsiruLtion is )zDuu or more, a KLLU Utu Notice of commencement is required.
SUS PLEMENTAAL CONSTRc,�fION LIEN LAW INFORMATION
SIGNER ENGINEER: N / _ of Applicable
MORTGAGE COMPANY: Not Applicable
Name: THELMA M BROOKS
Name: WILLAIM LASKY JR.
Address: 12001 Orange Ave Fort Pierce, FL 34945
Address: 12001 ORANGE AVE
City: VERO BEACH State:
City: FORT PIERCE State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: 4310 45TH ST
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 jobsite
before the first inspection. If you intend1to obtain financing, consult with lender or an atto ney before
commencingwork or recordingour tice of Commencement.
I
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Signature of Owner/ Lessee/Contr or s Agent for Owneri
Signature of Contractor/Licens H Ider V
STATE OF FLO�,D
COUNTY OF� iJ�Q,�
STATE OF FLORICK
COUNTY OF
The f instrume t as knowledged before me
The forT�I g instru, t wa acknowledged before me
this day of 20 jy by
this da 20�by
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Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
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Type of Identification
Produced
Produced
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17