HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date:_T�<D\ Permit Number: O-a 4a�
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RECEIVSD FEB 16 2016
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT.LOCATION:
Address: 3104 Duban Terrace
Legal Description: Silver Lake Park Addn Blk 11 Lot 3 and N 12ft.of Lot 4 (or 1920-1764)
Property Tax ID#: 2427-603-0147-000-0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAI.LED'DESCRIPTION OF WORK:
Replacing Roof
CONSTRUCTION INFORMATION;
Additional work to be nertormed under this permit–check all that appy:
HVAC L_J Gas Tank ❑Gas Piping Shutters El-Windows/Doors
Electric 0 Plumbing Sprinklers Generator-- �Roof
Total Sq. Ft of Construction: 1152 _S :-Ft:of First Floor:
Cost of Construction:$ 2350.00 m Utilities: l_I Sewer El Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Randy Thomas Name:
Address:3575 Sneed Road Company: /Jiq-/VDI//1—Lss..rrtC�"fia..+
City: Ft. Pierce State:FL Address: iQ O/ter jdl ez 'e/✓
Zip Code: 34945 Fax:77261-6668 City: d6�-- State:FL
Phone No.772-461-6228 Zip Code: Fax:
E-Mail:awrinc@hotmail.com Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CC 13
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:01lj�jc�rv�,�� ; � Name:
-
.._--.._
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:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
Ice"that no work or installation'has commenced.priorto 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.
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Signatur o Owner/Lessee/Contactor as Agent for Owner Signatuff of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_ 5-Y- -%,-a co COUNTY OF
The for oing instrument was acknowledged.before me The forgoing.instr .mQ�nt was acknowledged before me
day of '� � ,20-�6- by -this l�. day.ofr 20. by
\\A1'�041 Ram w.oY\, y ►\1d�,novq
(Name of person acknowledging) CCC(Name.of person acknowledging)
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(Signature of Notary Pu lic-State of Florida) (Signature of Notary Public-State of Florida)
• .. ,� YENS. .
Personally Known OR Produced 1. ��da Personally Known OR Pro edGP otF►o�nw
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Type of Identification �EPNN state° 6,`�n : Type of Ide ification ' a
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ProducedQ°b \�esa g16: Produced m• E�. a
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Commission No. 't'f � -MY d �0�9hNaC�p° Commission No. E�S, -(,gyp° Goad u9
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REVIEWS FRONT : TONING SUPERVISOR PLANS VEGETATION. ` SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014