HomeMy WebLinkAboutBuilding PermitALL 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) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: rCl e
Legal Description:
Property lax ID #: 3 Lot No. S5
Site Plan Name:
Project Name: �i-�j_ _-
Setbacks Front Back: Right Side: Left Side:
Block No.
Y e'er a tb wr- 6"4 �-•- I,^_J004_ - S 43, �rl2e.
CONSTRUCTION INFORMATION:
Additional work to be Derformed un er t is permit— check all appy:
HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Ei Generator E]Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ zz" ezc.)
S. FtFtj of First Floor: _
Utilities: LJ Sewer Septic
Building Height:
t1VVNER/LE5SE1=:
CONTRACTOR:
Name
Name: WAYNE THOMAS BURNETT
Address: -9<Q L 6rf iz (n n, (""4
Company: FHIA,LLC
City: Pte— S - J— L t r_je , State:
Address: 3044 SW 42ND ST
Zip Code: 3L4CKCK6 Fax:
City: HOLLYWOOD State: FL
Phone No.
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
It value of construction is 52500 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: WAYNE THOMAS BURNETT
Address:
Address:
City: HOLLYWOOD State:
City: 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 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 proper of Commencement must be recorded and posted on the jobsite
before the first inspectio y tend t obtain financing, consult with lender or an attorney before
commencingpc` or rdi g y ur Noti a of Commencement.
of
STATE OF FLORIDA
COUNTY OF
Agent for Owner
The forgoing instrument was acknowledged efore me
this _,� 1 day of 'M a f ch 20� by
A1ber+b 4. W117S0q-1
Name of person statement
Personally Known OR Produced Identification
Type of Identification
of Notary Publ
Commission No.
01-(r-0717 Z 2—
REVIEWS
REVIEWS FRONTI ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
LAUREN BIRX
t}t�'ry Public - State
Ccrrimission # GG
Sig t #ractor/Licens Holder
STA F FLORIDA /�/�tif
COUNTY OF
The forpoi g instrument was ac knowledged before me
this &Iday of Z 2 _ by
Nameof per aking statement
Personally Known OR Produced Identification
Type of Identifica
Produced
Public- State of Florida )
,CGU L A MERCADO
722 ='. ... _.*-My COMMISSION # G6095745
SUPERVISOR PLANS
REVIEW REVIEW
moi; ROVE
REVIEW REVIEW I REVIEW