HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFQ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l�
Date: 9,n I I 10, V Permit Number:, a'd Ia3
RECEIVED
Building P ;t A I; t'F
EC 2 O'.a18
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Roof - MR--QA
EL
PROPOSED IMPROVEMENT LOCATION: - '
Address: 5379 OLD DIXIE HYWAY, FORT PIERCE FLORIDA 34946
Legal Description: RIVERVIEW MANOR BLK A LOTS 13 AND 14 (OR 1832-2170)
Property Tax ID #: 1408-703-0013-OOD-7
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Tat c5 n, . eo its
A/_5 t�_kcvv*t-- , 1s 1-f6U��tst
Lot No.13 AND 14
Block No. A
CONSTRUCTION INFORMATION: 11
E1HVAC U Gas Tank
11 Electric ElPlumbing
Piping _Shutters ❑Windows/Doors
nklers Generator Roof FL, ' \ Roof pitch
Total Sq. Ft of Construction: Z--(o 5g 5 FtFt.� of First Floor:
Cost of Construction: $ SS 2B Utilities: L Sewer JSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name MICHAEL BURLEY
Name: EDWARD LECHNER
Address: 5379 OLD DIXIE HYWAY
Company: EDIFICIUM CONSTRUCTION
City: FORT PIERCE State:FL
Zip Code: 34946 Fax:
Phone No.
Address: 1215 CASTAWAY BLVD
City: VERO BEACH State: FL
Zip Code: 32963 Fax:
Phone No. 772 643 4513
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: EDIFICIUMROOFING@GMAIL.COM
State or County License: CCC1331308
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
erml pp ica i n
y-T, wcia County, Permitting
Commercial Residential
1; SUPPLEMENTAIL,CONSTRUCTION LIEN LAW INFORMATION:
Name:_
Address:
city: _
Zip:
SIMPLE TITLE HOLDER:
1215 CASTAWAY BLVD
State:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable -
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City: City
Zip: Phone: Zip:
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 intend to obtain financing, consult with lender or an attorney before
commencine work or recording vour Notice of Commencement.
G�
Signature of Owner/ Lessee Contractor as Agent for Owner
Signature of Contras-tor/License Holder
STATE OF FLORI�A
S. Lor1Z
STATE OF FLORIDA
5}.1-Sots
COUNTY OF
COUNTYOF
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledge before me
DkC
thisa0 day ofSi c 20l by
this\Zv day\\of 20a by
\
eA JarN UZCcAV\'Q!-
�.dO"fdt LDC�nt(�
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identi ' ationn
Produced � ri, {)� L
Produced ID
(Signature of Notary P lic- State of Florida )
(Signature of Not Fy Public- State of Florida )
Commission NO.Cs�O"�.a.0a VMS NOS
022013
COWENS
ommission No. �l i EAMIa 022023
DF
L,�MM\SS yer 16,202E
t.AY 5DeDem U�arHrnaR
My 0
S ';' EXPIRES: December 16.2020
Dfi SmyedTlw ND"Pub51;UadarsMam
REVIEWS
imt
FRON r+'»
'Ac gppd0d
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNT
EVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
12.12
Rev.8/2/17