HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED;1/20/17 Permit Number: 04s—
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division 1
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: 6740 N A1A ST LUCIE COUNTY FL
Legal Description: 03 34 40 S 125 FT OF GOVT LOT1 LYGE OF A1A(1.54AC)OR 3507-317
Property Tax ID#: 1403-120-0003-010-3 Lot No.1
Site Plan Name: Block No. S 125 FT
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
REPLACING LEAKING DOORS AND WINDOWS
CONSTRUCTION INFORMATION:
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Acid
itiona I work to be nertormed under this permit—check all iatappV":
HVAC Gas Tank []Gas Piping _Shutters ✓Q Windows/Doors
11 Electric ❑ Plumbing Sprinklers E]Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Flood:
GAJ
Cost of Construction:$ 3� P L1Z1J Utilities: _Sewer❑Septic Building Height:
,OWN ER/LESSEE: CONTRACTOR: _
Name KEN COOPER Name: JARROD BATH INC
Address:6740 N A1A Company: BATH CONSTRUCTION INC
City: ST LUCIE COUNTY State:FL Address: 2220 18TH AVE
Zip Code: 34949 Fax: City: VERO BEACH State:FL
Phone No.1-330-720-4632 Zip Code: 32960, Fax: 772-365-8338
E-Mail:bath@comcast.net Phone No. 772-778-8338
Fill in fee simple Title Holder on next page(if different E-Mail: bath@comcast.net
from the Owner listed above) State or County License: indian river county
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION_ LIEN LAW INFORMATION:
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,iniall 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.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Sig ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this of 20 llby this c)-';__day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Si n Lure of otary Public-State of Florida) (Sign to e�of Not nj Public St to of I rida
Personally Known OR Produced Identific t'o ersonally Known o uced Identification
Type of Identification Pro ype of Identification od� ed,
;�:r ••.,% LLE W.GRIFFIN
Commission No. _•: :� ublic,State of Florida =*i ,.= Notar
lommission No. Notary of Florida
;; � Commission No.FF 968968 Commission N .F
-. �F fMy Commission Expires 03/081 �''���° f`°A� My 968968
Commission oo F F
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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