HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL INFO rLIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C'05
Date: 1 l� Permit Number:
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 ✓
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IM R01lEMEIUT LCAT1tN f
Address: 0
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Legal Description: (�V2f \�GL(tC� -�a vu�1- 44 ' \� X60( L— '2-
Property
Property Tax ID#: 3i\\C(- 15-50- 000 "f Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
C?ETAILED DESCRIPTION'OI= WORK
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(n541JI o� r\0VAkMPa'CJ ins � s ern ���els
Additional work to be performed un er t is permit-check all appy:
❑HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ 5c�Uco f Utilities: _Sewer Septic Building Height:
NameLbe,f_k lkmm c y-w4un Name: Michael ODonnell
Address: ) \a Q c a c\ 2 Company: ODonnell Impact Windows
City:Po k !k I .,.J-C;j State: L Address: 6402 SE Federal Hwy
Zip Code: Z�Aq.g 3 Fax: City: Stuart State:FL
Phone No. '-T-'I;D -8_18 ���C'1 Zip Code: 34997 Fax:
E-Mail: Phone No. 772-408-0200
Fill in fee simple Title Holder on next page(if different E-Mail: rcodonnell311 @gmail.com
from the Owner listed above) State or County License: CRC1331273
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
51PPEMEiTLkCONSTRUCTIQN`LIf N �A1NrINtRMAT{4Ny s F
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.
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF W&fr.- I n COUNTY OF r(—1 n
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this__10 day of 20 Eby this day of 20 [4_by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produ
'0Y PUS
';o1pRY PUB(.... Ga�LE FULLER
Commission No. (Se
_; a' g)ALE FULLER C( mmission No.
MP�UT4IMISSION#FF06455
MY COMMISSION#FF064 8 "'
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EXPIRES October 20,201
E29,28 `
4 �) 15 or BNotaryService.com
Revised 07/15/2014 (4071398.0153 Florid allotaryservice.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS