HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: •�'���(1 Permit Number: V AS
• I RECEIVED
Building Permit Application
Planning and Development Services JUN 0 7 2018
Building and Code Regulation Division
ST. Uacie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Shed ffft
PROPOSED IMPROVEMENT LOCATION:
Address: 6406 Doris Dr; Fort Pierce, FL 34951
Legal Description: Lakewood Park-Unit 8-B-BLK 5 LOTS 18 AND 19
Property Tax ID#: 1301-610-0089-000-7 Lot No.
Site Plan Name: Shed Block No. 5
Project Name: Shed
Setbacks Front 96' Back: 22' Right Side: 123' Left Side: 17'
DETAILED DESCRIPTION OF WORK:
12' x 12' premanufactured shed &)W42RE7_,C
CONSTRUCTION INFORMATION:
Additional work to be nerformed under t Ispermit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Constructions: /(+4 S . Ft. of First Floor:
Cost of Construction:$ / , �� Utilities:cn Sewer 11 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Joyce Hadley e: Joyce Hadley
Address:6406 Doris Comp y:
City: Fort Pierce State: F� Address: 06 Doris Dr
Zip Code: 34951 Fax:772-468-9278 City: Fort Pier State:FL
Phone No.772-528-6273 Zip Code: 34951 x; 772-468-9278
E-Mail:jhadley@btef-cpas.com Phone No. 772-528-62
Fill in fee simple Title Holder on next page( if different E-Mail: jhadf-c
ley pas.c
from the Owner listed above) State or unty License:
If value of construction is$2500 or more,a RECORDED Notice of Com encement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Joyce Hadley Name: JoyceHadiey
Address:6406 Doris or:Fort Pierce,FL 34951 Address: 6405 Doris
City: FortPierce State: City: Fort Pierce State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:6406 Doris Or 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
commencing work or recording our Notice of Commencement.
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Signature I Owner/Lessee/Cont c r as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA1 STATE OF FLORIDA
COUNTY OF Lu(1,1 , COUNTY OF
The fo oing instrul ent was acknowledge efore me The forgoing instrument was acknowledged before me
this day of 20 '6 by this day of 20_ by
v(11 le- 1V
acme of person making katement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Commission No. PaY B�?I) KAREN d N1E ssi No. (Seal)
Commission # G
State of Florida N tary Public
207484
+ � M Cornmissio Expires
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REVIEWS FRONT Z VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17