HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
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ALL APPLICABLE INFO MUST BE COMPLe i rJ FOR APPLICATION TO BE ACCEPTED
Date: 3 (� I Permit Number:
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Application[7RECEIVE"D
12018
nty, Permitting
Commercial Residential X
PERMIT APPLICATION FOR: p
To Select from dro box, click arrow at the end of line
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PROPOSED IMPROVEMENT LQCITI ° '
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Address: 12001 ORANGE AVE FORT PIERCE, FL', 34945
Legal Description: 93639 BEG AT NE OCR OF W 1/2"OF E 1/2 OF NW 1/4 OF SW 1/4 RUN W 165FT, TH S 395, 4FT, THE 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 Lot No.
Site Plan Name: N/A Block No.
Project Name: N/A
Setbacks Front Back: Ri0ht Side: Left Side:
DETAILED DESCRIPTI IN;,OF WORK
TEAR OFF ROOF SHINGLE ON GARAGE AND INSTALL V-5 CRIMP
PITCH 4/12 SQUARE FEET 600
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iditional worK to be eriormed under this permitl— cnecK all apply:
11HVAC _ Gas Tank Gas Piping _ Shutters
Electric ❑ Plumbing []Sprinkllers 0 Generator
Total Sq. Ft of Construction: 600
Cost of Construction: $ 3,000
❑ Windows/Doors
W1Roof 4/12 Roof pitch
S Ft. of First Floor:
Utilities: Sewer Septic w Building Height:
OW,,NER/LESSEE•
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C4R CONTRACT
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Name THELMA M BROOKS
Name: WILLIAM LASKY JR.
Address: 12001 ORANGE AVE
Company: ATLANTIC ROOFING II' OF VERO BEACH FL INC.
Address: 4310 45TH ST
City: FORT PIERCE State: FL
Zip Code: 34945 Fax:
City: VERO BEACH State: FL
Phone No.
Zip Code: 32967 Fax: 772-257-5740
E-Mail:
Phone No. 772-492-8493
E-Mail: wljatr@aol.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: CCC1326188
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name: THELMAM BROOKS
Name: WILLIAM LASKYJR.
Ad d ress: 12001 ORANGE AVE FORT PIERCE, FL 34945
Address: 12001 ORANGE AVE
City: FORT PIERCE State:
City: VERO BEACH
State:
Zip: Phone
I
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 Recordia 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 at ey be,ore
commencing work or recording vour Votice of Commencement. !!��
Signature of Owner/ Lessee/Contraffodas Agent for;Owner
STATE OF FLORIDA
COUNTY OF.
The for ng instr m nt was acknowledged before me
thi day of� 2013? by
Name of person ing statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Si at a of Notary PLiblic- State of Florida 1 _ _ _ _ _ _ _
tim rrQ �Q' L. AUSTIN
Commission No. �� :*:
CID n#GG165615
�� 10 Expires January 6, 2022
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REVIEWS FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
re of
STATE OF FLORI
COUNTY OF �
r/License Holder
;�g instrum t was acknowledged before me
ay of 20' by
Name of person_,Wkingitatelnent
Personally Known OR Produced Identification
Type of Identification
Produced.
atur of Notary Public-
" DEBORM L. AUSTIN
nission No. Corrttrg# GG 165615
Expires January 6, 20rina22
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