HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABJE INFO JUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNEio Permit Number:
BY
St. Lucie cnqr?.f� v E D
Building Permit Application SEP 2 1 2017
Planning and Development Services Public Works
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPostb-IMIPROVEMENT LOCATION:
Site Plan Name:
Project Name:
Setbacks Front Back:
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Right Side: Left Side:
Block No.
9ETAlLElJDESCRIPTibNOF,WORK':
Dr4NQ11 removal *-'-Q,0Q0MeAti, WOO +Q,0acemoti pami
i0efior door Y-0-mowt + rQ-0cemut CO(HuOk ftPIOCaMf UP -it a'
CONSTRucTION INFORMATION: - -
Additional work to be nertormed under this permit- check all apply:
HVA( Gas Tank E]Gas Pipir _ Sh utters OWindows/Doors
Electric Plumbing E] Sprinklers Generator E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
Cost of Construction:$ 651(p(2n.00 Utilities1l Sewer []Septic Building Height:
I
,OWNER/LffSSEE:
CONTRACTOR:
Name B-11 Kinqs LL-C
Name: Michael J. Waldrop
Address: 1010-1 Ht -in* QuV-) I r-).
company: innovation Contracting, Inc.
City:pclilm V-Aeckah (21CArdftW-9. state: a
zip CocleF—;��9,4 I B Fax:
Phone No.
Address: P.O. Box 12757
City: Fort Pierce State: FL
Zip Code: 34979 Fax: N/A
Phone No. 772-519-9108
E-Mail:
Fill in fee simple Title Holder on 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.
DESIGN ER/ENGI NEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _NotApplicable
Name:
BONDING COMPANY:
Name:
—Not Applicable
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.LucieCoun makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in co 171ict 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
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvemeW to your property. A Notice of Commencement must be,*orded and posted on the jobsite
before theXrst inspection. If you intend to obtain financing, consult,)Ofth lender or an attorney before
as Agent
STATE OF FL
COUNTY OF
The.4orpinginstrum tw ac nowledgliLbeforeme
thist—I I dayof _C. 20J_1Jby
IC\ 44 OZ�M(tD
V r4am' e_�_fpelrso , n making statement
Personally Kn —_ OR Produced Identification
Type of Identi 1 a 10
ProducE ±_ IFL_ 1A
(Signature of Noly Public- State of Florida
ANrF1 M HUFFIaUdil
Notary Public - State of Florida
commission # FF 234730
17-1194
Rev. 8/2/17
JPERVISOR
REVIEW
0
Siybture 0 r License Holder
STAT �OF F
COUNTY OF
me
Name of person making statement
Personally Kn9wn —OR Produced Identification
Type of Iden ifi arn
Produced
-11
(Signature of N T ry Public- State of Florida
ANGELA M HUFF
Notary P . Ublic - State at Florida
MANGROVE
REVIEW