HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: 11C9 • ( 9'al
BY
St. Lucie County RECENE®
Building Permit Application SEP 2 9 2017
Planning and Development Services
Building and Code Regulation Division P=_Rk?i 7TiNG
2300 Virginia Avenue, Fort Pierce FL 34982 St. L_ .:e Coucty, FL
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:
Address:
�
Property Tax r :M•• ram• il► Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
DrL�wctll removed 4- replaced, i%ulckiion removed � replckced,
patnfi, interiorCkWr replQcernQ_nt. CDrt�wal1 replozemexnt up+o a'
r?tbove. floor CtLiLi to fWdiog4-y-omlrma
CONSTRUCTION INFORMATION:
itiona wor to a erorme under tispermit—check all apply:
E1HVAC Gas Tank ❑Gas Piping In _ Shutters Windows/Doors
11 Electric OPlumbing Sprinklers Elenerator Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ Fi.CIA. 00
S Ft. of First Floor:_
Utilities: Sewer I Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namegilfbimfe Commerr'idl ReaInveStt m 1 LLC
Name: Michael J. Waldrop
Address: Hal (21wr)gc cik StfPP_t
Company: Innovation Contracting, Inc.
City: �or-4 Pierr`t_ State:
Zip Code: 39P4q Fax:
Phone No. Slot -'J Iq — 3sSLD
Address: P.O, Box 12757
City: Fort Pierce _ _ State: FL
Zip Code: 34979 Fax: N/A
Phone No. 772-519-9108
E-Mail: +f(rJP J (8QPYJJ J 1 bQ_IIS0l I'tii
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 $2500 or more, a RECORDED Notice of Commencement is required.
CONSTRUCTION_ LIEN
LAW
� �,
,SUPPLEMENTA,L
INFORMATION
�� ;�hz$', 4 '�r
r` � , a� 9 � �,,
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:mnft*-��
Address:
Address:
City:
State:
City: Pq t plereg
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
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 prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or angcovenants 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
improvements t your property. A Notice of Commencement must be re rded and posted on the jobsite
before the firs nspection. If you intend to obtain financing, consult w' lender or an attorney before
commencin ork or r co in our Notice of Commencement.
Sign re of 0 e, ssee/Co trac r s Agent for Owner
Sign ure of Contra for/Lice se Holder
ST TE OF FLORIDA
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
i 7. �v.E -ry x/T�.++a( w>' c.+{{��j�rr a-.:alR' ti."ni n i'at'S
F..?�( ,y ,,•w a a,S t pra.�� �Arsy
� tf`;�'N, ✓u I t
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip:
Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not
Name:
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 County makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or andpcovenants 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
improvemerj$to your property. A Notice of Commencement must bewtordecl and posted on the jobsite
before theArst inspection. If you intend to obtain financing, consult th lender or an attorney before
as Agent for Owner
STATE OF Fl.
COUNTY OF
The for oing instrum nt w ac cnowledg before me
thi day of 20 by
c
ame of person making statement
Personally Knovkn OR Produced Identification —Z
Type of Identifi a io/
Produced L-
0"r\-^J'e � b, � rh
(Signature of NovPublic-State of Florida )
Commi0011:1
on,, o., • aur.Fi a M ZFF(Seal)
0.Y P`a`Notary Public - State of Florida 1t
•�:
•? commission if FF 234730
REVIEW
Rev.8/2/17
Sie/fature o r License Holder
STATE OF F A
COUNTY OF L tszC�
The
me
'Name of person making statement �—
Personally Kn wn OR Produced Identification i
Type of Iden ifi a on /
Produced
(Signature of Noory Public- State of Florida )
ANGELA M HUFF
Notary Public - State of Florida
MANGROVE
REVIEW