HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)4624553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION:., .
Address: ! .e jY)(,,r-t [)2- .ft•. PI crce -Fc 3-{ci �2
Legal Description: -1-OC lCty-, vi'( C51G .S
Property Tax ID#: C)3TZ-3-7_ Lot No. Z()•
Site Plan Name: USG. —Pcl��.DS Block No. 4G•
Project Name: l 1 SG, --?a,\.kV.(7c.
Setbacks Front 3 Back:, ' Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all-Jilt apply:
HVAC _Gas Tank nGas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Ell Sprinklers El Generator El Roof Roof pitch
Total Sq. Ft of Construction: Sr. Ft. of First Floor:
Cost of Construction:$ `Z 1�` ) Utilities: Sewer _Septic Building Height:
OWNER/LESSEE CONTRACTOR: ,
Name �,., 5f' I OL 1c)( • Name: WAYNE THOMAS BURNETT
Address: 530(0 m `Itilt" DOV Company: FLORIDA HOME IMPROVEMENT ASSOCIA
City: f+,PCI( Ce State: FL • Address: 3044 SW 42ND ST
Zip "340�fz. HOLLYWOOD FL
Code: Fax: City: State:
Phone No.� 1� — �'��— C Zip Code: 33312 Fax: 954'792-7977'
E-Mail: Phone No. 954-792-4415
Fill in fee simple Title Holder on next page(if different E-Mail: PERMITS@FHAPRODUCTS.COM
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
s -
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:WAYNE THOMAS BURNETT
Address: Address:
City: State: City: HOLLYWOOD State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:3044 SW 42ND ST 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 your Notice of Commencement.
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Signa re of Owner/Lesse /Contractor as Agent for Owner Slnatu + to nse Holder
STATE OF FLORIDA STATE OF FLO•IDA
COUNTY OF 5bvePt COUNTY OF
The forgoing instrument was acknowledged before me The(Argoing instrument was acknowledged before me
this '3o day of '� ,20r5 by this ''�I day 0-1%33�� , 20 I S by
L Nf& Pi,y/e,r
Name of person making statement Name of person ma g statement
Personally Known , OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificatio
Produced Produced
MIGUEL A M�� "a
MY GOMMI88lON#a
••1911 g,2021
{Signaierr�of Nuldi yplt}i Noite�tRFk r�a ) (Si: ature of Notar• •.. Ic-S ate;; ; forida
Commieo d*; MY COMMISSION#GG119g414
) ommissio �e (Seal)
'Q�s��
A. EXPIRES July 02.2021
REVIEWS FRONT ZONING SUPERVISOR ANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17