HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED MM Date: Permit Number: (1-109— 001c Li
SCANNED
BY
Building Permit Application St. Lucie county
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::, ;
Address: L
Legal Description: 0 C t_n i U M
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ProjectSite Plan Name: Block No.
Setbacks. -
DETAILED DESCRIPTION`OF WORK: III
Drywall removal, insulation removal) insulation replacem nt,
drywall WIO-zemQllt, pat;nt inttxi0r door frePl umR.n-t. (Drytval
CONSTRUCTION INFORMATION: v
tiona wor to e e orme under t—checkispermit a apply:
11HVAC �GasTank E]GasPip ing _Shutters ❑Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 5. ODO. � Utilities:iSewer 0Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name SYI0r-)l Inn I I C
Name: Michael J. Waldrop
Address:_PeC1Q0,lAS U)nyP_
Company: Innovation Contracting, Inc.
City: State: R
ZipCode: Fax:
Phone No— _ — T
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.
i
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name: error
Address: Address:
City: State: City: Fmtm«» State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: I Address:
Zip:
Zip: Pho
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 thepermitholder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an 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 T0 OWNER: Your failure to Record a Notice of Commencementrfnay result in your paying twice for
improverngfits to your property. A Notice of Commencement must b recorded and posted on the jobsite
before t first inspection. If you intend to obtain financing, consUth lend r or an attorney before
comme Ins work/or recording your Notice of Commencement. 117
�
gnatuie of 0 ner/ Lessee/Con ctor as Agent for Owner
Si ure of Con actor/Lice se Hold
TATE OF FLORIDA
ATE 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. (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
AfF(Di,.tlfil
��
j
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:
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 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 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 be orded and posted on the jobsite
before theArst inspection. If you intend to obtain financing, consult th lender or an attorney before
comme ng work of recording your Notice of Commencement. _
as Agent for Owner
STATE OF FI.
COUNTY OF
The for oing instrum nt w ac cnowledg before me
thi day of 20jby
` 4 1,
ame of person making statement
Personally Kno OR Produced Identification
Type of Identif1 a i0
Produced L—
(Signature of No Public- State of Florida )
nrrrci n M HUFFheaq
Notary Public - State of Florida
commission 8 FF 234730
EW 1 REVIEW
COMPLETED
Rev.8/2/17
STATE OF h0l A COUNTY OF I Lc!'i�
me
'Name of person making statement
Personally Kn wn OR Produced Identification
Type of Iden ifi ajion � /
Produced f �/ d
(Signature of Noory Public- State of Florida )
ANGELA M HUFF
Notary Public • State of Florida
MANGROVE
REVIEW