HomeMy WebLinkAboutBuilding Permit Application -iPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:- it)-Lo-* Permit Number:
RECEITED,OCT 0 6 1015
Building Permit Application
Planning and Development Services
Building ornd Code Regulation Division
2300 Virginia Avenue,Fort Pierce F4 34982
Phone:(772)462-1553 Fax-(772)452-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: -- 4ter ntiol Lzd—\L
Legal Description:
Property Tax lD#. Lot No.
Site Plan Name: Block No,
Project Name.•
Setbacks Front Back, Right Side: Left Side:
I Me- 11-sr 1,11fe- Tse111s'e< nxfisc- *'r /L2/tj-/
Additions lworlobeperformed under this Vermit.."chpck-bli t1fat appy:
—Mechanical Gas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
j/L
Cost of Construction-$ Utilities: —Sewer _Septic Building Height:
Name Lee- Name: Curtis
Address: 11LJjQJAt�,-a&Qj -LDQr)L_Q.�Q- Company: -&<:ram Vr S*Sfe.-M.5 )AJ c-,
City: otr 2± State:,LL, Address: l 15 4 Q rl&iL Dr -
Zip Code: tLLft�' Fax:— City:-LO State---EL
Phone No. rJ1Z- %nLlo-L Zip Code: 3495% Fax: 3,5D i
E-Mail: Phone No. 172 3a;5 -3�?
Fill In fee simple Title Holder on next page(if different E-Mail: c-"toor ,qLj1-ego).e.,eyox--
from the Owner lined above) State or County License: C-A C 05 IX 10
if value of construction is 2osWor more,a RECORDED Notice of Commencement Is required.
'7r*I I
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: •,Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip:�PhOne:
FEE SIMPLE TITLE MOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 cerrify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a Aermit will authorize the permit holder to build the subject structure
which is in conflict with an applicable Rome Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult w�th 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 recorftg your Notice of Commencement.
'Signature of Owner/Agent/ essee Signature of ContractorlLicense Holder
STATE OF FLORIDA STATE OF FLORIDA -
COUNTY OF �r cr'� �>R COUNTY OF t3 �u 'c'
The forgoing instrument was acknowledged before me a forgoing instrument was acknowledged before me
this day of Qa�-r .20 by �, his day of Q�. .� �t ,�0 ►0 by
�rJOL.
(Name of person acknowledging) Name of person acknowledging)
I All
��
( ignature of Notary Pub State of Florida) Sign ture of Notary Public- to of Florida )
Personally Known '� OR Produced Identification ` Personally Known OR Produced Identification „•
Type of Identification Produced Type of Identification Produced.
Commission No. ffaahgTS (seal) Commisslon No. FF 'Z�'rl� (seal)
REVIEWS FRONT ZONING,.' SUPERVISOR, PIANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW' REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED,
Rev.
�� "lc4 0 r �C�--
j 511 -00W
TERMITE PRETREAT SPECIALISTS 1 =800=D'ILIGENT
lololg MyDiligent.com
®�® state License JB228623
TERM/TE SERV/CES
Notice of Preventative Treatment for Termites
(as required by Florida Building Code(FBC)2326.5 and Broward County Chapter FBC 105.2.2)
CONCRETE WASHOUT SERVICES I TERMITE PROTECTION I PEST CONTROL I MOSQUITO CONTROL I RODENT CONTROL
SERVICE ORDER NUMBER 165370 SERVICE DATE 04/20/2017 TIME 08:00 am WEATHER CONDITIONS Clear
DEVELOPMENT NAME(PROJECT) CONTRACTOR'S NAME CONTACT PERSON
Tarpon Flats -: Lot 26 Phoenix Companies Inc. Cla ick
STRUCTURE ADDRESS(LOT/BLOCK) CITY,STATE,ZIP CODE COUNTY
3903 Duneside Drive Fort Pierce FL 34949 Saint Lucie
CONTACT PHONE NUMBER NOTES
561-799-5900 Exterior perimeter for renewal and final
TREATMENT TYPE/AREA
❑FLOATING ❑MONOLITHIC ❑PATIO ❑GARAGE ❑DRIVEWAY ❑STEM WALL ❑ADDITION
❑CUTOUTS ❑FOOTERS ❑FRONT ENTRY ®EXTERIOR PERIMETER FOR RENEWAL ❑OTHER
TREATMENT TYPE
❑TAMP&TREAT ❑TREAT ONLY FINAL ❑RETREAT ❑BORA CARE TREATMENT ❑TERMITE BAIT STATION
PRODUCT
*DOMINION ❑ADONIS 2F ❑PREMISE ❑DEMON TC ❑TERMIDOR ❑BORACARE ❑OTHER
ACTIVE INGREDIENT Imidaclonrid
CONCENTRATIONp
❑.05% C3.06% 4).1% ❑.12% ❑.25% ❑OTHER- GALLONS APPLIED 71o AITE%5
SQUARE FOOTAGE 2,000 LINEAR FOOTAGE
SQUARE FOOTAGE VERIFIED
*YES ❑NO ❑MEASURED OR VERIFIED PER PLANS
41
JOB READY CONDITIONS MET 7a
9YES ❑NO DETAILS
SAFETY CONDITIONS Good conditions
As per 2326.5 FBC-If soil chemical barrier method for termite prevention is used.Final exterior treatment shall be completed prior to final building approval.
Certificate of Compliance:The building has received a complete treatment for the prevention of subterranean termites.Treatment is in accordance with rules and
.laws established by the Florida Department of Agriculture and Consumer Services.(Per the Florida Building Code.)
If this notice is for the final exterior treatment,initial and date this line AB 04/20/2017 (TERMITE MONITOR INSTALLED ❑YES ❑NO)
FINAL STICKER
❑ELECTRICAL PANEL O WATER HEATER OTHER
Payment Terms: Customer's payment in full is due at time of initial service.Customer agrees that a finance charge in the amount of 18%per annum will
be assessed on all unpaid balances that are not satisfied by the due date. In the event a collection process becomes necessary to recover an unpaid
balance the following fees will be assessed including but not limited to: collection service fee,attorney's fee,finance charges and non-sufficient funds
payment fee. Customer will be responsible for paying all costs associated with any collection process.
04/20/2017
Date Applicator(Diligent Services)
B
Date Customer(Property Owner or Agent)
Corporate 3500 NW Boca Raton Blvd. I Suite 714 Boca Raton,Florida 33431 1-800-DILIGENT