HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY
..;A 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
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address:
Legal De!
Property Tax ID #: I I —
Site Plan Name:
Project Name:
Setbacks Front Back:
— C I )I I - ( U X I -
Right Side: Left Side:
Lot No.
Block No.
Dr, V\,Qkk (kmo�jak aad repiocemkat; inso Ick-hon remavcxI wict replckcellR�em
PQiM,t V\A-er, Or ckoor 're-PIQCement. CUI-4,0alk t-eplacement L.XP -b 2:
0b0Ve_ �-JCO( dLAe -ko �JOOCIMCII TfOM
3amonaiWUrKTQoeoeriorrneu unuerLtiisperITUL—LI
1JHVA M Gas Tank DGas Piping
11 Electric El Plumbing []Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 17S PQQ- 00
S'hut'ters 0 Windows/Doors
Generator EIRoof = Roof pitch
S Ft of First Floor:
Utilities: Sewer 0 Septic
Building Height:
bW N ErTwh
tO N T
Name Alkany-p Inc-
Name: Michael J. Waldrop
Address: Q A a C)' Sca v-ck A-pqa F)aN _LT
Company: Innovation Contracting, Inc.
City: V\ie,%t PQJ M J�)eiCk CAq State: E�,
Zip Code: -:,:;?S4(DCJ Fax:
Phone No.
Address: P-0, 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.Gom
State or County License: CGC1511910
if value of construction is $2SOO or more, a RECORDED Notice of Commencement is required.
,�b CWEWAL-t
ON:--'K
4-
DESIGN ER/ENG I NEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name: m*h9ew-*m&a*-
Not Applicable
Address:
Address:
City: State:
Zip: Phone
city: Fmwielm
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY:
Name:
—Not Applicable
Address:-P,
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 holderto 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 T99WNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvemerigto yourProperty. A Notice of Commencement must be Wcorded and posted on the jobsite
before the�rrst inspecti if you intend to obtain financing, consult h lender or an attorney before
commeng?fig work orModing your Notice of Comme cement. /�"
Si re of Ow /Con c or as Agent for Owner
SIE/ature 0 "OClor/License Holder
TATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTYOF
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
'N' i
VM
DESIGN ER/ENGI NEER: Not Applicable
Name:
MOR I TGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City: State:
Zip: Phone
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 priorto the issuance of a permit.
St. Lucie Coun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in co %ct 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
improvemeoto your property. A Notice of Commencement must beetiorded and posted on the jobsite
before theArst inspection. If you intend to obtain financing, consu en der or an attorney before
commen,e,Tng work of recording your Notice of Commencement. r - I
as Agent for Owner
STATE OF Fl.
COUNTY OF
The.t( oing instru IedgW before me
thisf"�L I clay of 0J_1Jby
C'� vN C,A
gam- e 5f person making statement
Personally Kn —_ OR Produced Identification
Type of Identi 1 a 10
Produced
(Signature of No Public- State of Florida)
AmrFl M HUFFtaeay
Notary Public - State of Florida
commission # FF 234730
Rev. 8/2/17
REVIEW
Sirture_51`��r License Holder
STAT DF A�A
COUNTY OF 5—�—
me
'Name of person making statement
Personally Known OR Produced Identification
on
Type of ]den Ifi a
Produced ff�
(Signature of Noory Public- State of Florida )
ANGELA M HUFF
Notary Public - State of Florida
MANGROVE
REVIEW