HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
12/22/2016 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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 4000 Avenue L
Legal Description: Sunland Gardens BLK 30 LOT 16 and E 1/2 17
Property Tax ID#: 2405-601-0559-000-7 Lot No.16&E 1/217
Site Plan Name: Block No. 30
Project Name:
Setbacks Front Back: Right Side: Left Side:
4
aE A)LED,DEuS'CR)PT)4N OF UIfaRK g
Demolition of House
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Additional wor to e e orme under t is permit—c eC a appy:
HVAC E]Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing []Sprinklers Generator Roof
Total Sq. Ft of Construction: S . of First Floor:
Cost of Construction:$ 5,770.00 Utilities:Sewer Septic Building Height:
u .. �. �A'...
Name Guilford Dieuvil Name: Cheryl Ajacquin
Address:8757 Baystone CV Company: P&C Construction of the Treasure Coast, LLC
City: Boynton Beach State:FL Address: P.O. Box 4343
Zip Code: 33473 Fax: City: Fort Pierce State:FL
Phone No. Zip Code: 34948 Fax: 772-461-0095
E-Mail: Phone No. 772-216-8900
Fill in fee simple Title Holder on next page(if different E-Mail: Pcconstructiontc@aol.com
from the Owner listed above) State or County License: CGC056649
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required:
�St1PPLEMENTAL CONSTRUCT[�N LIFN lAW INFC3RMATION:
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x 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 thepermit 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 wor r recording our Notice of Commencement.
s
_Signature ofO1V#
Lessee/Agent Signature of Con actor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ZA _ )a tL COUNTY OF ac_1Z
The forgoing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this ` day of 20 Eby this_aa..day of 'Z�2.Cern17.cC :20 1 U by
(Name of person acknowledging) (Name of person a cnowledging)
(Signature ofNotary Public-State of Florida) (Signature of N tary Public-State of Florida)
Personally Known V OR Produced Identification Personally Known .,/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. FF`��$y�S (Seal)
-40°t, Nota Public State of Florida aY o
�00'
® Alyssa Modine ? Alyssa Modine
Revised 07/15/2014 �oe`°Q My Expires 04/14/2019 ommission FF 206475 %C CoQ ExpiMy irommission FF res 04/14/2 19 205475
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS