HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J// !�
Date: Permit Number: / (P V
RECEIVED
•
Building Permit Application SEP 14 2016
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: Fence
PROPOSED TIM PROVEMENTIOCATION:
Address: 4003 S Indian River Dr, Ft. Pierce, Fla.34982
Legal Description: 35 35 40 S 100 ft of N 240 Ft of E 1/2 of NE 1/4 with RIP RTS-less RD&FEC RR-(2)
Property Tax ID#: 2435-111-0002-000-7 Lot No.
Site Plan Name: Block No.
Project Name: CHAYA
Setbacks Front 5' Back: Right Side: Left Side: 6"
DETAILED DESCRIPTION"OF WORK:
N 57.A u 159 a 7'—' �., U W c f/_ 0-6al 1 c}U
CONSTRUCTION_ INFORMATION.
Additional work toe nertormed under tis permit—check all appy:r
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 1915 Utilities:Sewer[]Septic Building Height:
OWNER/LESSEE CONTRACTOR':
Name Chaya, Elenore Name: Ross A.Chambers
Address:4003 S Indian River Dr Company: Adron Fence Co
City: Ft. Pierce State:Fl Address: 1132 NE 12th St
Zip Code: 34982 Fax: City: Okeechobee State:FI
Phone No.772-528-4074 Attn:Barry Freedman Zip Code: 34972 Fax: 863-763-8404
E-Mail: Phone No. 800-282-5172
Fill in fee simple Title Holder on next page(if different E-Mail: adronfence@live.com
from the Owner listed above) State or County License: 18971
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
..SUPPLEMENTAL CONSTRUCTION LIEN-LAW INFORMATION,; °: .
SIGNER/ENGINEER: _Not Applicable MOR T AGE COMPANY: _Not Applicable
Na e: Name:
Addr Address:
City:_ State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TIT L HOLDER: _Not Applicable BONDING COMPA 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.
'Z / axl� W s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF OKEECHOBEE COUNTY OF OKEECHOBEE
The forgoing instru�j,e�nt was acknowledged before me The forgoing instrument was acknowledged before me
this `�day of Sx/fIJ� 20'/-6 by this 9 day of SEPTEMBE 20 /1by
ROSS A.CHAMBkRS ROSS A.CHAMBERS
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida.) (Signature of Notary Public-State of Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produ• d---zn of Identification Produced
"%.'Vk'ya'-.,, DOREEN ELARDI -�
;o` �-- ,.•``ayP rqea�OREEN ELARDI
Commission No. D ;_* •�� 5�►�I}�ry Put'':_S
State of FI rifle mission No. O86 , t" a tl
« * My Comm. Expires Oct 21,2018 ; �� N 7ary ut"-.-State of Florida
?•« *•_ M Comm.Expires Oct 21,201
Commission #FF 1500 7 :N1* • y p
Bonded Through National Notary Assn.' -,FOF
Revised 07/15/2014 . ,
"'�����•` Bonded Through National Notary Assn.
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DATE
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