HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONyt 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED permit Number: 1 Ci9L
BY ..
St. Lucie County
SEP 2 1 2017
Building Permit Application Public work
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _ ) Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION:
•• i aa Kings ■ _ Sn- D- ���
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Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Dryu,W removotl and replacement, insulation removal and veplocemwi-,
paint, interior door replacefw- (DryWa.A replacemQ )t up to a
CIUOV -Vooc CM ooca l n -" om Irma
CONSTRUCTION INFORMATION:,
ia¢ionat worx tO De errormea unaer wis perm¢— cr
LIHVA( 11 Gas Tank ❑Gas Piping
Electric El Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
L 1Shutters Windows/Doors
Generator Roof = Roof pitch
S Ft. of First Floor: _
Utilities: Sewer D Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name —T)yA0mQs ' l/\1PSthOf_F
Name: Michael J. Waldrop
Address: Q iVP_r DriV a
Company: Innovation Contracting, Inc.
City::EeQ,UeStCt State: R
Zip Code: a 3�q 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.
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DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY: NotApplicable
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 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 the rst inspection. If you intend to obtain financing, consult th lender or an attorney before
cnmmen nu work of recording vour Notice of Commencement. _ 4
STATE OF FL
COUNTY OF
as Agent for Owner
MAM
The for oing instrum t w ac cnowledg before me
this day of 20,� by
ame of person making statement
Personally Kno OR Produced Identification —Z
Type of Identifi a ioJi
Produced 2—
0.\'t'a
(Signature of No Public -State of Florida )
an c,Fi a M HUFFtJra'f
Notary Public - State of Florida
commission S FF 234730
DATE
Rev.
REVIEW
STATE OF FiOltl A )
COUNTYOF S� G.ISLCb�
me
'Name of person making statement
Personally Kn wn OR Produced Identification
Type of Iden ifi aon V /
Produced k—/ / I
(Signature of Noory Public- State of Florida )
ANGELA M HUFF
Notary Public - State of Florida
MANGROVE
REVIEW