HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED s� `
Date: )- 0. ) / Permit Number: lelo/—o
0
_�=IVED
Building Permit Application
Planning and Development Services -••
J 8 2019
Building and Code Regulation Division n
2300 Virginia Avenue, Fort Pierce R 34982 `- 1 (p
p � 1County, Permittm i
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Modular home III
Address: 122 DUSK WAY
Legal Description: TROPICAL ACRES BLK B LOTS 103,104 AND 105 (1.05 ACRESI
Property Tax ID #: 2308-601-0162-000-9
Site Plan Name:
Project Name: LAFOUNTAIN
Setbacks Front70' Back: 205.68' Right Side: 22' Left Side: 52'
Lot No.103,104,10:
Block No. B
I DETAILED DESCRIPTION OF WORK: I . .
NEW DCA MODULAR HOME 28X66'
CONSTRUCTION INFORMATIOW
Aaaltional wof t0 Ile nertormed under tispermit-check affn
apply: _
ZHVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 1848 Sq. of First Floor:
Cost of Construction: $ 176,958.00 Utilities:[]Sewer Septic Building Height: 17'
OWNER/LESSEE:
CONTRACTOR:
Name HENRY & CELESTE LAFOUNTAIN III
Name: JAMES FITZGERALD
Address:122 DUSK WAY
Company: DBK INDUSTRIES, INC
City: FT PIERCE State:FL
Zip Code:34945 Fax:
Phone No.772-584-6126
Address: 560 NW 13TH CT
City: PLANTATION State: FL
Zip Code: 34772 Fax:
Phone No. 407-709-1490
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail. tomsmh.ed@gmail.com
State or County License: CGC059461
it value or construction is $z5uu or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
-Name:
MORTGAGE COMPANY: _ Not Applicable
-Name. —
Addressz,.
Address:
City: �" State:*
Zip: Phoney
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
AddreSS:560 NW 13TH CT
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 priorto 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 exemptfrom 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.
Sign ure of O ne a see/Contractor as Agent for Owner
Signa a of Contract /Licen older
S TE OF FLORIDA
S OF FLORIDA
C LitOF ST LUCIE
C UNTY OF ST LUCIE
The forgoing instrument was acknowledged before me
JANUARY
The forgoing instrument was acknowledgeSL before me
this 7 day JANUARY 2Q by
Is day of 20 by
of
Name of person making statement
Name of person making statem t
Personally Known X OR Produced Identification.
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
ProducedoL
Pr ucedOL
(Signatu f,.'ob i .. uwj 81l 0
'(Signatulre of Not Public -State of Florida I
ARUS 1R
t • MY COMMISSION
Commission f' N
Commissi Nq
ebruary f0. 2C18 6q
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�c MY COMMISSION B18)'@yg
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EXPIRES
REVIEWS
FRONT
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SUPERVISOR
PLANS
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%
VEGETATION
ry
ANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17