HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I')`'( 'a' I I( � Permit Number: ' I "'a1 C
I
.�_- _— :,--- RECEIVED
COUNTY ' '
F Building Permit Application Nov""1.3 2010
Planning and Development Services Pert, Lucting�Cou tment
Building and Code Regulation Division St' Lucie county
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: door y'<
'PROPOSED IMPROVEMENT LOCATION:
Address: 5900 PALM DRIVE, FORT PIERCE FL 34982
Legal Description: INDIAN RIVER ESTATES-UNIT-08-BLK 62 LOT 19(MAP 34/11S)(OR 3333-1962)
Property Tax ID#:
3402-609-0377-000-5I
Lot No.
Site Plan Name: PEPERA Block No.
Project Name: PEPERA
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
FURNISH AND INSTALL 1 PC. MASONITE 36" X 80" FRONT ENTRY DOOR
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit—check all- apply:
IIIHVAC IIGas Tank Gas Piping ShuttersEl.Windows/Doors
0 Electric 0 Plumbing Sprinklers 0 n Generator - I 1 Roof Roof pitch
I
Total Sq. Ft of Construction: 5Ft.of First Floor:
Cost of Construction:$ 260.00 Utilities: Sewer El Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name HEATHER PEPERS Name:
Address:5900 PALM DR Company:
City: FORT PIERCE State:FL Address:
Zip Code: 34982 Fax:N/A City: State: I
Phone No.772-409-3688 Zip Code: Fax:
E-Mail:HPEPERA88@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: _Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address: I
City: State: City: State: I
Zip: Phone: Zip: Phone: it
I
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address: it
City: City: 'I
Zip: Phone: Zip: Phone:
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: work or recordin_ our Notice of Commencement.
_ 'MEW" op / , ,
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF TATE OF FLORIDA
COUNTY OF FLORIDA,S i UjC( � COUNTY OF
The forgoing instrument wa acknowled a before me The forgoing instrument was acknowledged before me
this j.. day of NOV , 20 / (by this day of ,20 by
S
41/.11 I -19ei - '
(Name of person acknowledging (Name of person acknowledging)
/ ' C
(Signature of It aro,;�: = - (Signature of Notary Public-State of Florida)
\ PAY PV
a°` eo- tate of FIoNd A o G H N
Personally Kno Ig'7 *_ oBrfifiq;�J #)c I ' Personally Known OR Produced Identification
Type of Identif IaY�j�
' ^'-s�luc�bY Commissi. ..• ,• i Type of Identification Produced ,I
•
Commission No. ea " " Commission No. (Seal)
Revised 07/15/2014 l
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
1 INITIALS