HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' a? Permit Number: —
- Building Permit it Applicati®n
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
PRCIPQSED IMPROVEMENT LOCATIC}N, �
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Address: "01/ 8,11SA- 'VRiye
Legal Description Indian River.Estates-Unit 09-BLK 80 LOT 12(MAP 34/12S)(OR 2073-2812)
Property Tax ID#: 3402-610-0303-000-0 Lot No.12
Site Plan Name: N/A Block No. 80
Project Name: N/A
Setbacks Front Back: Right Side: —Left-Side:
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�ITAIEQ DESCRIPTION i FPQRK � 5 "�
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Replace old T1-11 wood siding with new T1-11 wood siding, and paint. '0 ).e—
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CCNSTRUCT(ON INFC►RMAT� CON
Additional
wor to ee orme � rm
under this peit-c ec a appy:
❑HVAC 11 Gas Tank Gas Piping _ Doors
11 p g Shutters ❑Windows/
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 0 SFt. of First Floor: 0
Cost of Construction:$ 2,000.00 Utilities:cnSewer 0Septic Building Height:
O11IER/LESSEE 'CONTRACTOR: 1 'z ,
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Name Rq4(#A U Artyd Name:
Address: 3-900 VAL-54m 'P/Zrr/E Company:
City: CFoxt I rL State: FL Address:
Zip Code: 34982 Fax:N/A City: State: .
Phone N o.561-373-4689 Zip Code: Fax:
E-Mail:randyslattery71@gmail.com Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION,LIEN LAW,INFORMATION
DESIGNER/ENGINEER: x 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:
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
commericin work or recording our Notice of Commencement.
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Signature of O /Lessee/Contractor as Agent for �`: ;•: Signature of Contractor/License Holder
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STATE OF FLORID STATE OF FLORIDA
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COUNTY OF COUNTY OF
The for oing instrument was acknowledge efore >48 o The forgoing instrument was acknowledged before me
this day of 20P a mi� this day of ' 20_ by
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Name of pers making statement °';s Name of person making statement
Personal own OR Produced Identificatio � p� Personally Known OR Produced Identification
Type of Identi ' tion —N Type of Identification
Produced 4w Produced
(Signature of Not Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17