HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED G(�� n
Date: SCANNED Permit Number: 1109.0 a_6a
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 III
PROPOSED -IMPROVEMENT LOCATION:'- III
Property Tax ID#:II^ eco—col =)—cyn—rJ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
oNwall removed + ceplac(35, ineoulahon remveci+neplacea, po iat,
Interior cicOr replaced. CDr1V-)a11 Replaced L,Lp -b a' 0 'J-e -Moor diu
AD �tmdi -from 1ffm)
CONSTRUCTION INFORMATION:
onalworxtooe ertormed unaertnispermit—cl
HVAC Gas Tank []Gas Piping
Electric Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 6,02n .60
Shutters ❑ Windows/Doors
Generator Roof = Roof pitch
Sai —F—t.� of First Floor: _
Utllltles: L) Sewer 0 Septic
Building Height:
OWNER/LESSEE:
'CONTRACTOR:
Name )
Name: Michael J. Waldrop
Address: Q ?,ol McQdon "Drive
Company: Innovation Contracting, Inc.
City: FOrt Pierce State: FL
Zip Code: ?�NgSI 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 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.
SUPPLEfVIEfVTAL CONSTRUCTION LIEN LAW INFORMATION
�" ti,,
_'
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name:
Name: "&'-'
Address:
Address:
City:
State:
City: rorta'--
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not
Applicable
Name-
Name:
Address: Q,&-4w�
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 holder to 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 TOO NER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvemen o your propert . A Notice of Commencement must b recorded and posted on the jobsite
before the st inspect,on. I u intend to obtain financing, cons with lender or an attorney before
comme work or ecor I.
our Notice of Commencement.
gnatuurre r Lessee/Contracto t for Owner
gnatu of nt actor/License Holder
STATE OF FL RIDA
STATE 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
dxv
a�'."' R OW
M
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY:
Name:
— Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip:
Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
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. Lucie Court makes no representation that is granting a permit will authorize the permit holder to build the subject structure
onfl which is in cict 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
improveme to your property. A Notice of Commencement must beptorded and posted on the jobsite
before theyffrst inspection. If you intend to obtain financing, consult th lender or an attorney before
commen f ng work of recording vour Notice of Commencement.
as Agent for Owner
STATE OF FL
COUNTY OF
The forgoing instrum nt w ac nowledged before me
this day of . - 20 by
game of person making statement r
Personally Kno OR Produced Identification
Type of Identiftiof i /
(Signature of Noly Public- State of Florida j
NNrFl A M HUFFPCOI/
Notary Public - State of Florida
commission M FF 234730
-w I COUNTER I REVIEW I REVIEW
Rev.8/2/17
Signature o r License Holder
STlX OF F A
COUNTY OF
me
'Name of person making statement �''
Personally Kn wn OR Produced Identification P
Type of Iden 1 1 am � J
Produced �/ 14
(Signature of Noory Public -State of Florida I
ANGELA M HUFF
Notary Public - State of Florida
MANGROVE
REVIEW