HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONM
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION -TO BE ACCEPTED
Date: Permit Number:
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Build>Ing Pe mit Application
Planning and Development Services es Q',Pertmen
Building and Code Regulation Division ®gAfN
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 COrlmerCial Residential X
PERMIT APPLICATION FOR: Building I J
-e
Address: 6810 N. State Rd. 7
Legal Description: Bay St. Lucie That Part of Lot 21
Property Tax ID #: 4422-502-0025-000-0 I Lot No. 21
Site Plan Name: Block No.
Project Name: Rockwell Residence
Setbacks Front Back: Right Side: Left Side:
ODE:TAILED DESCRLPTIO:N:OF V11;ORK' ;, :
Install Push Piers, supplemental support
GON$TRUGTfQN INFORNIATIQN.:':
orme un ert is permit —
itiona wor to n_GasTank ❑Gas
c ec
a
app y:
a Windows/Doors
C�HVAC
Pipinlg
Shutters
❑ Electric 0
Plumbing
El Sprinkle Is
Generator
L Roof F Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
Height:
Cost of Construction: $ 27,909.58
Utilities:[]Sewer
i
Septic
Building
OW;N�R/LESSEE'.: ; ':: :......
CONTRACTOR;•.
Name S Kent Rockwell
Name: Matt H. Nolton
Address: q60 Penn Ave Stp 400
Company: Nsquare Inc.
City PittsbyLgh State P�
Address: 7770 T...d.•. Ctmntar Way
City: NnpIPa State: FL
Zip Code: 15222 Fax:
Zip Code: 34109 Fax: 239-514-2273
Phone No.
ll�
E-Mail:
Phone No. 239-514-1173
Fill in fee simple Title Holder on next page (if differ ant
E-Mail: srieke@nsquareinc.com
from the Owner listed above)
State or County License: CGb045302
if value of construction is $z5uo or more, a KtLLiKuru ry IL16C UI
00
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SUPRLEME�NTAL CONSTRU'CTION:'LIEN: LAW
DESIGNER/ENGINEER: _ Not Applicable
N am e: Mark Weber
Address: 8810 N. State Rd. 7
City: coconut -creek State: FL
Zip: i33073 Phone 954-617.8143
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone'
OWNER/ CONTRACTOR AFFIDVIT: Application is herel
I certify that no work or installation has commenced prior to
O RiVIATIO N;
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: S Not Applicable
Name:
Address:
City:
Zip: Phone:
lade to obtain a permit to do the work and installation as indicated.
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 Comm ehcement 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
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Signature of Owner/ Le tp ra=or as or Owner
�V
S' nature of Contractor/License Holder
STATE OF FLORIDL
STATE OF FLORIDA
COUNTY OF p t Q�
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COUNTY OF C v l,Ll ej�
The forgo] instr ment was acknowledged before me
The forgoing instrument vias acknowledged before me
this-2— y of i , 20•& by
1T 20 1 � by
this ��lay of,�
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"�%F' lb 1'10 Y1
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known /_ OR Produced Identification
Type of Identif cation
Type of Identification
P ced AC
oduced
(Signature of No 9bkb9- Sfaf„F
(Signature of Notary Public- State of Florida
,fir%: "-'r•, CAROLINA ITURBURLI
Commission No. COMMIOIMI�FF990995
—
(1A2I•)NAITURBURU
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Commission No. .S Fb •.7COIAMI
�( 5 r: :' • to�� EXPIRES: May 10, 2020
1� �pt �+ 'r=' SSION# FF 990995
Bonded Thru Notary Public UnderwritersEXPIRES:
May 10, 2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
ISEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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