HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ++ l
Date: May 4,2015 Permit Number: 1 Ss ln0 l 4
s
Building Permit Application
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: Demolition
PRO`POSER]MPROVEMENT LOCATION
Address: 160 Lamont Road
Legal Description: 12 35 39 from SW cor of SW 1/4 of NE 1/4 run E 47 FT,Th N 760 Ft for POB,th cont N 295.17 FT,The 295.....
Property Tax ID#. 2312-132-0002-000-4 Lot No.
Site Plan Name: NA Block No.
Project Name: NA
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Demolition of Single Family Residence
CONSTRUCTION INFORMATION:
Additional work to be performed under t ispermit—check.a appy:
❑ F]Gas Piping Gas Tank _ Windows/Doors
pin g Shutters ❑
Electric 0 Plumbing Sprinklers Generator ❑ Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 2200.00 Utilities:O Sewer El Septic Building Height:
011UNER/LESSEE ":'.'CONTRACTOR:' .
Name Margaret H.Carlton Name: Scott Miller
Address:160 Lamont Road Company: Facilities Construction One, LLC
City: Fort Pierce State:FL Address: P. O. Box 12208
Zip Code: 34947 Fax: City: Fort Pierce State:FL
Phone No. Zip Code: 34979 Fax:
E-Mail: Phone No. 772-466-5992
Fill in fee simple Title Holder on next page(if different E-Mail: scott@facilitiesconstruction.com
from the Owner listed above) State or County License: CGC1516421
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION.LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: 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:
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
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
_Sig re of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID % STATE OF FLORIDA
COUNTY OF �, COUNTY OF
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged_before me
this , day of 20�by this day of 20 by
s
(Name of person acknowledging) (Name of person acknowledging)
NiAnalture of Notary Public tate of Florida) (Signature of Nota lic_State of Florida)
I r�,, NGHA�lllp
Personally Known OR Produced Identification Personally Known =`` OR ptpdtt4e�Ideificai�ip�
Type of Identification Produced Type of IdentificatioPr ' _"d M rM� ®'-Ill'(D20ia"C!i =9,F o�� Co;nmission#FF 17"'
Commission No. (Seal) _ -- -Com is 'on No. i Bonded thrd�e�$ona- A
LASHAHNMN RAM i"
Revised 07/15/2014 Ir' My Comm.Expires Dec 20.2018
Commission # F` 117249
REVIEWS FRONT A. ING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
=INITIALS