HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
SCANNED Permit Number. I IZ�J I (, 3Q�
BY
St. Lucie County
Building Permit Application SEP c" 1 2017
Planning and Development Services Public Work,
Building and Code Regulation Division St. Lucie county, FL
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
-PROPOSED IMPROVEMENT LOCATION:
Address:
- • • � 111- ilh 1
ProjectKIN MORE= RE
Property Tax I D #: Lot No.
Site Plan Name: i 2H3 c��l OMEJ Block No.
Setbacks Front Back:_ Right Side: Left Side:
L`DETAILED DESCRIPTION OF WORK: III
Dril.3u- ll removed and replacecl,, insLkA"orN remo\iecl, apa
fe�DtQ•c,edl PoL'►n+, in+erior door repaceme it. CDrLp.01 replace 3'
Up is 2! above-�100v We tD ficiodingFrom Srrna )
CONSTRUCTION] N FOR MATION:
Ari'litinrt.1 to h. n.rfnm,cH indor this norm it— rhprle a I I t nt nnn v
UHVAC Gas Tank Gas Piping UShutters ❑ Windows/Doors
11 Electric Plumbing Sprinklers U Generator Roof Roof pitch
Total Sq. Ft of Construction: SaI —F�t. of First Floor:
Cost of Construction: $ Utilities:n Sewer Septic Building Height:
.OWNER/LESSEE:
CONTRACTOR:
Name T And T (0P Elorida I_LG
Name: Michael J. Waldrop
Address: 1 LA 8--52 2.2 nd POQd NOC-th
Company: Innovation Contracting, Inc.
City: i—OXCIVI Ory mee. State: _L.
Zip Code: ?5?J' 4-10 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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MORTGAGE COMPANY: _ Not Applicable .-
Name:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Address:
City:
Zip:
State:
Phone
City:
Zip:
State:
Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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
improvemeri0to your property. A Notice of Commencement musX'eorded and posted on the jobsite
before th rst inspection. If you intend to obtain financing, consuender or an attorney before
commen ' ne work of recordine vour Notice of Commencement. _
' nature ner/ Lesse ntractor as Agent for Owner
Si ature o r License Holder
STATE OF FLORIDA % `
STATE OF F A ) r
COUNTY OF
c T� Ly l Si,�L`�—
COUNTY OF L�
The for oing instrum
thi day of
t w ac nowledg before me
20 by
The fo4going instrur =t�wass aac%nowledg efore me
this flay of ,\(�_[ . 201l
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Del f A \ Y l"1Llr—
ame of person making statement
'Name of person making statement
N
Personally KnT
OR Produced Identification
Personally Kn wn OR Produced Identification
Type of Identi10
Type of Iden i i a ion
Produced
Produced
(Signature of Notty
Public-State of Florida)
(Signature of Noory Public -State of Florida )
Comm!rio f).,
nur,vi a M HUFF(Seal)
Com eal)
;`Notary
Public - State of Florida
; oU.^"�a ; ANGELA M HUFF
'Cammission
q FF 234730
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°' . Notary Public - State of Florida
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REVIEW
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REVIEW --
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17