HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: o� o� Permit Number: IcO°�-do-i II
Building Permit Application FEB 12 2019
Planning and Development Services ST. Lucie G
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMITTYPE:
PROPOSED INPROVEMENT LOCATION: %LP,Gr; 'Io i Ni fit
Address: 12772 NW Mariner Ct
Property Tax ID #: 4425-603-0010-000-1
Site Plan Name:
Project Name: John Dodge
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
Villfr llVA;(6A(P (A k(1110( ql MiUnkll I la,4p( 5IA WAN_FI 0
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: Moo S�
Cost of Construction: $ 102100
1)Ia 2100
Generator K_ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name John Dodge
Name: Matthew Drozd
Address:12772 NW Mariner Ct
Company: Diversified Roofing Solutions Inc
City: Palm City State: _f-U
ZipCode:3T7gt0 Fax:
Phone No.
Address:450 S Old Dixie Hwy #1
City: Jupiter State: FL
Zip Code: 33458 Fax:
Phone No561.f841.5676
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailgeris@diversifiedroofingfl.com
State or County License CCC1330205
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip:
Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
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 b recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult it9l lender or an attorney before
commencine work or recordine your Notice of Commencement. I I I 1
41
C
rgnature of Owner/ ssee/Contractor as Agent for Owner
Signature o Co ct /License. Holder
STATE OF FLORIDA Q
STATE OF LORI A
COUNTY OF PA Beach
COUNTY OF Palm Mac
The fo oing instru ent was acknowledged before me
The for oing instrument was acknowledged before me
this day of �� 20� by
this day of f� 20 L by
Su san L. XAd t rs oN
M• A�rttiW_U -a74z
Name of person making statement.
Name of person making statement.
Personal) Know ReFwr�o��duced tQ`�gficaRMNER
Personally Known x .�.- . • OR Produced Identification
Type o Identification r' bs Notary Public - state of Florida
Type of Identification .
Produced ommission a FF 959053
Produced
My Comm. Expires Feb 21, 2020
-
"- BondedlMoupM1 NatMnai Notary Assn
•,
yy woa'muua5 H0N _W ""
(Signature of Nota Public State of Florida)
(Signature of Not ry i - 0& F&idX
00 900DO a NOISSIWWO0
Commission F q58 a5
Apq
No. (Seal)
Commission No. -LUDe 1 NIUgjSealf",3
" REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Hev. 9/26/18