HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application A��G
Planning and Development Services PEREIII I INIQ
Building and Code Regulation Division 5t. Lucie County I=L
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Window/door
PFtOPOSED,INPROUEMENT LOCATION
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ddress: q0 Q6 CAC.r n u,V A-v_ - � �o�-� cS� �.t,��u,�L +'ELa�49 SZ.1
Legal Description: 1?6'Y111- 'Ur1'�-
Property Tax ID#: Lot No. 1
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ED,DESCRIPTION A. WORK
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CONSTftUCTI{}N INFORMATION
Additional wor to e e Orme under this permit—Check a appy:
HVAC F]Gas Tank []Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer[]Septic Building Height:
01NNERjLESSEECONI RACTOR
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Name N), 16 q— 'Don I EV Name: Wayne Thomas Burnett
Address: yr)y .� rot 6nu* Company: Florida Home Improvement Associates
City: T&YA— State:FL Address: 3044 SW 42 St
Zip Code: 3�qs� Fax: City: Fort Lauderdale State:FL
Phone No. 7!�2—&_AO Zip Code: 33312 Fax: 954-792-2170
E-Mail: Phone No. 954-792-4415
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CGC061890
If value of construction.is$2500 or more,a RECORDED Notice of Commencement is required.
Sl1P�LEMI=NTAI CO`N�TRUCTI' NryLIEI $LA1N iNFC}RMA`flt N= a s
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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:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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 work OpTeeia[cling your Notice of Commenc e
S nature of Owner/Agen ee Si atu a of Contractor/License Holder
co SIATECIFFLORIDA STATE OF FLORIDA
.z °T COUNTY OF �&W' . ty fm COUNTY OF
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# Th forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
Z th /O day of 8� 20�by this_day of 200 by
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U (N)me of person acknowledging), (Name of person acknowledging}
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gnature of NotaryPub is-State of Florida} (Signature o c tary Public-Sta of Florida Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.6 A 11 gt4y F (Seal) Commissio (Seal)
JANETTE L LUNN
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ISSION#GG03299Revises(07/15/2014 EXPIRES August 07,2020
REVIEWS FRONT ZONING SUPERVISOR PLANSION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED