HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -i
Date: 7/26/2016 Permit Number:
RECEIVED JUL 2 9 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: �— � , �'`d '
PROPOSED IMPROVEMENTILOCATION ,W
Address: 207 N 39th ST
Legal Description: WILBUWE BLK 6 S 30 FT OF LOT 16 AND N 45 FT OF LOT 17 (0.21 AC)(OR 3808-439)
Property Tax ID#: 2408-603-0071-000-7 Lot No.
Site Plan Name: Block No.
Project Name: Renovation
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONOF.WORK � =;z = , `� . - ,
1. Replace damaged t111 siding on back of house under patio
CONSTRUCTION.,I,NF lRMATIQN
-,
Additional work toe e orme under this permit-check a appy:
HVAC E]Gas Tank Gas Piping _Shutters ❑Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: 1540 S Ft. of First Floor: 1540
Cost of Construction:$ 1400.00 Utilities:Sewer[]Septic Building Height:
OaWNER/LESSEE ;x :,CONTRACTOV
Name Samuels Investment Properties LLC Name: Roderick Waller
Address:4000 N A1A unit 402 Company: Sunrise City CHDO
City: PO Box 814358 Hollywood State:FL Address: 800 Virginia Ave
Zip Code: 33081 Fax: City: Fort Pierce State:FL
Phone No.786-246-7121 Zip Code: 34982 Fax: 772-907-0420
E-Mail:deanne-samuels@yahoo.com Phone No. 772-201-2850
Fill in fee simple Title Holder on next page(if different E-Mail: rodwallerl@gmail.com
from the Owner listed above) State or County License: CGC1515114
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW.INFORNIATION:
DESIGNER/ENGI NEER: _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.
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_Signature of Owner/Les a/Agent Sign ture of Contractor/Lic rise Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SA-. L%ac 2 COUNTY OF 'C
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this� day of ;::Y61\1 20 \5—by this_!� day of ` 20 \5�_by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publ State of Florida) '", (Signature of Notary ublic-State of Florida) "
.�,�...� S oc+da .���°`�"' EPN�ca�2)�°Florid16.
Personally Known ORtP.rod'G`c lN27�r�tS i��tib Personally Known �OIj; roduced Ic� + ,-- 't, Zn
Type of Identification Rro ;�{�ed La�' �e°15' 1( Type of Identification ProdU( 'e<' j�ta Ices De9111
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--� Gom �E Assn., _ issl°n ly°laty Assn.;
Commission No. J } 1 �y Sed nal °ta+y_�r=' Commission No. � _ T `� G0�( eaf�iNali°nalr,•�'r
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Revised 07/15/2 1'4��-~ w J
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS