HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit Application MAY '14 2015
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 Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 617 Winters Creek Road 1�
Legal Description: Ilarhouc Ride ��G.'1 ?U [_O+ q
Property Tax ID#: y qj, � "g jd' 00 1 q -000_(, Lot No. H
Site Plan Name: (� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all appy:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric ❑✓ Plumbing Sprinklers 1:1 Generator E] Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 1 9 00 09- Utilities:1n Sewer 1:1 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Laforge Name: Robert W.Ludlum
Address:617 Winters Creek Road Company: Aqua Dimensions Plumbing Services Inc
City: Palm City State:FI Address: 1651 SW Macedo Blvd
Zip Code: 34990 Fax: City: Port St Lucie State:FI
Phone No.772-283-0553 Zip Code: 34984 Fax: 772-343-7418
E-Mail: Phone No. 772-344-8433
Fill in fee simple Title Holder on next page(if different E-Mail: aquadimensions@netzero.com
from the Owner listed above) ' State or County License: CFC057526
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DES ENGINEER: Not Applicable MORTGAGE COMPANY:' .Not Applicable
Name: Name:
Address: Address:
City: , state: _ City: State:
Zip: Phone- Zip: —Phone-
:FEE SIMPLE TITTLE HOLDER: . _Nat Applicable BONDING COMPANY: _Not Applicable .
Name: , Name:
Address; Address:
City: city:
Zip:• _Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie cou* makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which Is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Horne Owners Association and review your deed for any restrictions which may apply.
in consideration ofthe•granting of this requested.permit,I.do•hereby agree that I will,in ail respects,perform the-work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a fuliconcurrency review:room additions,
accessory structures,swimming pools,fences;walls,signs,screen rooms and'accessory uses to another non-residential use
WARNING-TO OWNER:Your failure to Record a Notice of Commencement may result'in your paying twice for
improvements toyour property.A Notice of.Commencement must be recorded and posted on the jobsite
before the first inspection.if you intend to obtain financincan It with lender or an attorney before.
comm' cin work or recordin our Notice of Comri:9ntr$for/LIcensa
s
_Signature of Ow J Lessee/Agent Holder
STATE OF FLORID / STATE OF FLORIDA
COUNTY OF, bdu-t _ COUNTY OF sr.Lucw
The fo going Inst ent was acknowledge are me The forgoing instrument was acknowledged before me
.this�day of ,�_, 20 D� this 90th day of Ands 20 _„____by.
lyRabsrtw..Lvd1um
(Name of person acknowledging)- (Mame of person acknowledging)
(Signature of NotaryiPlublicJtate of Florida} (Signature of Notary Pub c Stateltif Florida)
•Personally•KnowmOR Produced Ideritificatlon Personally Known X OR Produced Identification
Type of Identification Produced Type of identification Produced
Commission No. SDA LAFFF-R'f C mmission No. �' �1� ,cC 1 (seal)
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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