HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I % -7 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
OPt SED°I*ROVEMENT LOCATION. }
Address: 17580 Hammock Lane
Legal Description: HIDDEN ACRES BLK C LOT 1 -LESS E 360.75 FT- (MAP 32/11S) (1.28 AC) (OR 3841-348)
Property Tax ID #: 3211-811-0016-000-2
Site Plan Name:
Project Name:
Setbacks Front JJ/A Back:
Installing Manufactured Shed 12X12 (144 Sq Ft.)
Left Side: --
Lot No. 1
Block No. C
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CONTRA �gR gx -,7 3y
Name Kimberly T Scott
Name:
Company:
Address: 17580 Hammock Lane
City: Fort Pierce State: FL
Address:
Aciclltiona wor to
a e orme under this permit — check all
Phone No. 772-971-4884
appy:
E -Mail: kimberlyscott0392@gmaii.com
Fill in fee simple Title Holder on next page ( if different
HVAC
Gas Tank
Das Piping
_
Shutters
Windows/Doors
11
Electric
❑ Plumbing
Sprinklers
E]
Generator
Roof
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $;;V— oc)
SFt. of First Floor: _
Utilities:11 Sewer O Septic
Building Height:
_
4`
CONTRA �gR gx -,7 3y
Name Kimberly T Scott
Name:
Company:
Address: 17580 Hammock Lane
City: Fort Pierce State: FL
Address:
City: State:
Zip Code: 34987 Fax:
Phone No. 772-971-4884
Zip Code: Fax:
Phone No.
E -Mail: kimberlyscott0392@gmaii.com
Fill in fee simple Title Holder on next page ( if different
E -Mail:
from the Owner listed above)
Stat or County License:
VO UC V a.v1143u uuwn lb ac3uv yr more, a Krt.UKuty rvotice OT [+Ommencement is required.
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FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
DESIGNER/ENGINEER: X
Not Applicable
MORTGAGE COMPANY:
X Not Applicable
Name:
REVIEW
Name:
REVIEW
Address:
REVIEW
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 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 your Notice of Commencement.
s
as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF. • u-'�C -ca- I COUNTY OF
The forgoing instr ment was acknowledged before me
this day of - 20 O_by
(Name of person ackn ledgin )
(Sigture of Notary Public- State of ida )
Pers ally Known_ OR Produced Identification
Type of Identification Produced _ _ ------
Commission
_____
Commission No.
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this _ day of 20 _by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
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LD
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(W- reftWISS104N F# 210712 ommission No.
EXPIRES: AprN 26,2D19
Bonded Tbrn N*1 Pubic Under kft
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS