HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o. / ' % / Permit Nurin
Building Permit Applicati
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATIONFOR:
DO KU
Address: 3746 WHITE WAY DAIRY RD FORT PIERCE, FL 34947
Legal Description: 17 35 40 E 140 FT OF W 112 OF S 112 OF S 1/2 OF SW 1/4 OF NW 114-LESS S 48 FT -(0.91 AC)
Property Tax ID #: 241 1-z3n-Uuusuuu-
Site Plan Name:
Project Name: DOUGLAS
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
GENERATOR INSTALLATION SCANNED
BY
)} St. Lucie County
MUUILIUI IGI VVUI& LU UM I IVI IIICU UIIUCI UIq PC[ I I IIL—LIICI.R GII apply:
�" ^ HVAC Gas Tank Gas Piping Shutters Windows/Doors
Electric 0 Plumbing�` Sprinklers Generator Roof Roof pitch
biq
Total Sq. Ft of Construction: b / 1 Q V I) n S Ft. of First Floor:
Cost of Construction: $ Utilities:Sewer 0Septic Building Height:
OWNEB�„��E :
CQNC�t1Ei
Name REBECCA ANTHONY DOUGLAS I RICHARD CALVIN BUTLER
Name: GARETT GUIDROZ-
Address: 3746 WHITEWAY DAIR RD
Company: COMPLETE ELECTRIC INC
City: FORT PIERCE, FL State:FL
Zip Code: 34947 Fax:
Phone No.704-576-3259
Address: 637 SEBASTIAN BLVD
City: SEBASTIAN State: FL
Zip Code: 32958 Fax: 772-388-2411
Phone No. 772-388-0533
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: cregan@completeelectricinc.com
State or County License: EC0001911
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address: 637 BEBABTIAN BLVD
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 1 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
commencing work or recording your Notice of Commencement.
Signat re'of-Owner/ Lessee/Contra as-Agen- -rTer r
3ignature,of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORMA mot—'
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COUNTYOF ��c 'an'VC✓
COUNTYOF .J—�F��h/'
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
VY\M'—L —
this!I dayof /Y\O12h 2011 by
this day of 20_Laby
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G are=Lk r4L,:,, all
Name of person making gAtement ��
Name of parsojWking statement
Personally Known OR Produced Identification
Personally Known l/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of No ry Public -State f Florida I
(Signatur o Notaryubl2 3 IDr(a)Y Public -Slate of Florl
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Rev.8/2/17