HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: / --I V910 4
-_—==---_— - SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie County
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 I
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Address:
Legal De!
sok a5a(9-1115) Unit B 103 phase a (OF, 36'I t —Ljpaa'
Property Tax I D #: 051 1— C ]i. JU — C n I ( ei — non — a Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
/DETAILEb DESCRIPTION OF •'
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CONSTRUCTION INFORMATION:`
none wor to a nerformed under tispermit-check all apply:
�HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric 0 Plumbing Sprinklers ElGenerator 0 Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ C; OOC ). o0
S Ft. of First Floor:
Utilities:nSewer Septic Building Height:
.OWNER/LESSEE:
CONTRACTOR:
Name venture-S LLC
Name: Michael J. Waldrop
Address: d
Company: Innovation Contracting, Inc.
City: Dee-rei 0d Beach State: F(,
Zip Code: 5-54 {•a— [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.
SUpPLEMENTAC CONSTRU�CTIOfV
LIEN L,4W�INFORMATION 3 �` .,y �` � � . _ ' '� ; t
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:+*�
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City: F-H'' —
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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. Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con list 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 NER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvemen o your property. A Notice of Commencement must be r circled and posted on the jobsite
' st insp c . n. If you intend to obtain financing, consul before the t h lender or an attorney before
commen ' work r cording our Notice of Commencement.
r/ Lessee/ ntractor as Agent for Owner
S' natrFLORIDA
ure of Contractor/Licens Holder
STAT
STATE OF FLCDU
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
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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 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 conliict with any applicable Home Owners Association rules, bylaws or andcovenantsthat 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 beotorded and posted on the jobsite
before the/grst inspection. If you intend to obtain financing, consult th lender or an attorney before
Agent
STATE OF FL
COUNTY OF
The for oing instrum nt w ac nowledgW before me
thi day of 20 by
I'lt � i
ame of person making statement
Personally Kno OR Produced Identification
Type of Identifi a i0Ji
Produced 1
(Signature of Not fky Public- State of Florida )
uA rFI A M HUFFNea9
Notary Public - State of Florida
Commission # FF 234730
COMPLETED
Rev.8/2/17
REVIEW
0
Siarfature o r License Holder
STATE OF F AS__�— COUNTY OF /�-
RP
'Name of person making statement �^
Personally Kn wn OR Produced Identification
Type of Iden di lion (� J
Produced ' _; 11
(Signature of Noory Public -State of Florida )
ANGELA M HUFF
Notary Public - State of Florida
MANGROVE
REVIEW