HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: 1-10 9
BY
St. Lucie County RECEIVED
11111111111111P Buillding Permit Application SEP 2 12017
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County FIL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRQ'POgEDimpkbVEMENTLOCATIP.N.�lI
Address:_Z15 153, King-S HiNN 'F(3ri- F�_ a-APe4s
Legal Description: First Source Commerce Park Condo�inium (OR C-3eic9a'-1-116) Unii A-105
PhClSe I (61R,
PropertyTax[D#:
Site Plan Name:
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
Lot No.
Block No.
J-PETAILEb DESCRIPTION OFWOR_K:
Drywall rerfcvW and repJQCMWt, insuMilon removol, cmict
cepOcmetAt, paint, inter(or door replicLeleount- MrywO
v'n ni nf%n r" () ni- I i r-% +-/\ ni n V-)A% if) P-1 A�V- (I I 1 1) 1, eltv-% ri ; n(-i Rr�A -V v-rn^
J,
CCI`N�T]RucriON, INFORMATION:
AaaitionaiworKtODenertormed under this permit -check all apply:
E1HVAC Gas Tank E]Gas Piping In Sh utters Windows/Doors
11 Electric Plumbing E] Sprinklers Elenerator 0 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. a f First Floor:
Cost of Construction:$ Utilities:1] Sewer DSeptic Building Height:
OWNER/LESSEE:'.
'CONTRACTOR:
Name 1206 i.
Name: Michael J. Waldrop
Adclress:_IEPAS S. K_inQS Hto4
company: innovation Contracting, Inc.
City: Fhv+ State: fL
Zip Code: -;3!5 -C:-) Fax:
Phone No.
Address: P.O. Box 12757
City: Fort Pierce State: FL
Zip Code: 34979 Fax: NIA
Phone No. 772-519-9108
E-Mail:
Fill in feesimple'ritle Holderon next page (if different
from the Owner listed above)
E-Mail: mwaldrop@innovationcontracting.com
State or County License: CGC1511910
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
�'M ENTA CONST
T N
T
'_
DESIGNER/ENGI NEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
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 permitto 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 Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in co 1xict with any applicable Home Owners Association rules, bylaws or an9covenants 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
WARNIN OWNER:pyour failure to Record a Notice of Commencement y result in your paying twice for
_"our rop
improverneTnot., yo erty. A Notice of Commencement muft be corded and posted on the jobsite
J,t/be
cor
before the fil inspecti n. If you intend to obtain financing, cons ilt i h ler der or an attorney before
commenciX, ork or r2ording your Notice of Commencement.
ature of Owjo�_%�ontracto_rTas Agent for Owner
SiP ctor/ucense Hol6er
R A
TATE OF FL1l&
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this —day of. 20 by
this _ day of . 20_ by
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 Identification
Produced
Produced
(Signature of Notary Public- State of Florida
(Signature of Notary Public- State of Florida
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
MINNOWS--
om
DESIGN ER/ENGINEER:
_'NotApplicable
MORTGAGE COMPANY:
Not Applicable -
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: —NotApplicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby madeto obtain a permitto do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.LucieCoun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in co 1%ict 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
improvemeo to your property. A Notice of Commencement must beoEorded and posted on the jobsite
before theArst inspection. If you intend to obtain financing, consult
�sffth lender or an attorney before
STATE OF FL
COUNTY OF
as Agent for Owner
M-M-0
The�Tf rqoing instrurn tw ac nowledgyLbeforeme
t 1 0 ' 2
h day of 0J_1Jby
V Rarrie-o7-piaison making statement
Personally Kn -_ OR Produced Identification
Type of Identi i a 120 1FZ_
Producc 14
(Signature of N otey Public- State of Florida )
A1JrF1 A M HUFFtJCd1J
Notary Public - State of Florida
commission # FF 234730
1671-VIIA
Rev.
REVIEW
STATE OF ACRIDAS,
COUNTYOF LLIC'i
me
'Name of person making statement
Personally Knkwn __ OR Produced Identification
Type of Idenn 'on �,_/
Produced 7 14
(Signature of N ry Public- State of Florida
eal)
-da. ea
A 37E HUFF
Ni !LA M ff�UFF
ic _ Sta e at Florida
Notary Public - State of Florida
MANGROVE
REVIEW