HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: Permit Number:
=JRECEIVEDBuilding Permit ApplicationPlanning 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
I
PROPOSED IMPROVEMENT LOCATION:
Address: 5002 Hickory Dr
Legal Description: Indian River Estates- UNIT 07-BLK 46 LOT 9(MAP34/02NANDS)(OR 3997-2510)
Property Tax ID#: 3402-608-0204-000-9 Lot No.9
Site Plan Name: Block No. 46
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Temporary Power Pole, Master Permit#: 1706-0477
CONSTRUCTION INFORMATION:
Additional work to be nertormedunder t ispermit—check all apply:
HVAC LI Gas Tank Gas Piping _Shutters F—]Windows/Doors
Electric ❑ Plumbing Sprinklers 11 Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 500 Utilities:cn Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
�X�P4-u2 <_t��� - - - Name:
Name — '�Q+RL�� �-�,� (.(-� Francis Scott Parkman i
Address: `1Si I Sc 1!'v1,C`t �-'(� Company: Parkman Electric, Inc.
City: State:FL Address: 11415 SW Fox Brown Rd
Zip Code: Fax: City: Indiantown State:FL
Phone No. Zip Code: 34956 Fax:
E-Mail: S� �yTiQCCJU c;eu.Tl lc- ( 0AA5 rructgv Phone No. 772-597-1617
Fill in fee simple Title Holder on next page( if different E-Mail: parkmanelectric@aol.com
from the Owner listed above) State or County License: EC13002192
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:Francis Scott Pa,kman
Address:5002 Hickory Dr Address:
City: State: City: lndiantown State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:11415 SW Fox Brown Rd 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 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
commencin wort-C- r-ecording your Notice of Commencement.
ignature of Ow=DA
ssee/Contractor as Agent for Owner ign ure of Co ractor/Licen of er
STATE OF FLO STATE OF FLORIDA
COUNTY OF --1(. 1--0 cue COUNTY OF
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this day of �qw1 201 by this�—day of�r%%" ,20� _ by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced L L Produced
'ENS
d!S i.lN#GG 022023
Eserry
(Signature of Notary € ", _.gbf FI D ( ignature of Nota Public-State of Flog au
rie
O�n �Vrtuerwite s NOTARY PUBL
STATE OF FLO I A
Commission No. Commission No.�,a11 ol.Sl�l I -
ST. Lucie county, Permitting Y Comm#GG072 1
S Expires 2113/20 1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17