HomeMy WebLinkAboutBUILDING PERMIT APPLICATION) - I I ------
ALL APPLICABLE INFO MUST BE COMPLETEMIFOR APPLICATION TO BE ACCEPTED
Date:
SCANNED Permit Number: 09 -wo
BY
St. Lucie County
Building Permit Application
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 X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
'PROPOSED IMPROVEMENT.LOCATION:r
Address:
Legal Description: —7Fd'wJ
(OR a5aQ-np) uni-y ciap 9hase_
PropertyTaxlD#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
DETAILEO PES'CRIPTibN]OF WORK:
Dr4L,uctj� cemoved ancA replctc-ca, inGLAICk-tiOn r-emoved 0.(id reOCLceA
pc1iR-t, inieriocciocir reploucemzftt� CjDr�u)a�k (-eptac'emiu)t LLp fc) 21 OJDm
A00y' CAUe it> �Mdj(\q �f()M -r4-?CMO-
CONSTRUCTION, INFORMATION:
0 HVAC
FiGasTank E]Gas Piping
U Sh'ut'ters
11 Windows/Doors
11 Electric
0 Plumbing OSprinklers
1:1 Generator
E]Roof Roof pitch
Total Sq. Ft of Construction:
4�5
S'C Ft of First Floor:
12 []Septic
Cost of Construction:$
(000.00 utilities:
Sewer
Building Height:
OWNER/LESStE
CONTRACTOR
Name, )ohn Lench Qcd I_iCdQ_LeCKh
Name: Michael J. Waldrop
Address: ( 0 1 k I— CQLAO,1!�_ "ON BI \/CJ
Company: innovation Contracting, Inc.
city: Ve'lro gear-0 State: ja,
ZipCocle: _7)&01L0_6 Fax:
Phone No.
Address: P.0, Box 12757
City: Fort Pierce State: FL
Zip Code: 34979 Fax: NIA
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 at construction is 5250 or more, a RECORDED Notice at Commencement is required.
0,0.
DESIGN ER/ENG IN EER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:mfeit�
Not Applicable
Address:.
Address:
City:
Zip: Phone
State:
City: 9-4-p�
Zip: Phone:
—State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
—Not Applicable
Adclress:.A.&-Be�
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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in coNict with any applicable Home Owners Association rules, bylaws or and covenants that ma estrict or prohibit such
ic
structure. Please consult with your Home Owners Association and review your deed for any restrictions yhi h may apply.
w
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 9XNER: Your failure to Record a Notice of Commencern Vnt r:sult in your paying twice for
c
cc
0�
improvernep Z,ferty. A Notice of Commencement must I rd d and posted on the jobsite
0 you 'r
h IC
before the t inspectloto you intend to obtain financing, consult 7 h lender or an attorney before
commenc!Hworkorr ordinavour Notice of Commencement. /
Si t re of wrier ssee/Contractor as Agent for Owner
SigwPe.QLQGK&��er
S ATE OF FLO IDA
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. (Sea 1)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
DESIGNER/ENGI NEER: Not Applicable
MORTGAGE COMPANY: -
Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _NotApplicable
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 priorto 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 conWict with any applicable Home Owners Association rules, bylaws or ang covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and re ' view 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
improveme_Wto your property. A Notice of Commencement must be �9.ordecl and posted on the jobsite
before the
,Arst inspection. If you intend to obtain financing, consult�Ath lender or an attorney before
as Agent
STATE OF FL
COUNTY OF
The.f,orgoing instrurn t w ac nowledgW before me
this ayo . 20 y
c" ca 4e-JI,
V llarine 'of pelrsc�n making statement
Personally Knon OR Produced Identification
Type of Identifis a i0fi r_1 /
(Signature of Notey Public- State of Florida
&Nr;F1 M HUFRaUdil
Notary Public - State of Florida
commission # FF 234730
REVIEW I REVIEW
Rev. 8/2/17
0
Sirture 0 r License Holder
STAT �OF F A
L
COUNTY OF
me
'Name of person making statement
Personally Kngwn OR Produced Identification
Type of Idennr . n
Produced
(Signature of Noory Public- State of Florida )
ANGELA M HUFF
Notary Public - State Of Florida
MANGROVE
REVIEW