HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED01
Date:, 1 aal 1� Permit-Number:
-.`� ,, RECEIVED
� • � ' JUL 2 2 1.0'9
�- - Building Permit Applicatio
Planning and DevelopmentServices y
T.
4icW7 unty, Permltting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential - XXX
PERMIT TYPE: . DRIVEWAY
PROPOSE6WPROV.EMENT LOCATION,
Address: ' 5811 BAMBOO DRIVE FORT PIERCE, FL 34982
Property Tax iD#: 3402-610-0352-000-8 Lot No. 4
Site Plan.Name: THEISEN DRIVEWAY Block No. 82
Project Name: JEREMY THEISEN DRIVEWAY
DETAILED DESCRIPTION='OF WORK .yw k
REPAIR 2 SECTION OF EXISTING DRIVEWAY AND FORM UP&POUR CONCRETE 47'X-16!AND REPLACE
CULVERT PIPE
CONSTRUCTION.INFORMATION'"
Additional,work to be performed under this,permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric =Plumbing _Sprinklers _.Generator —Roof _ Pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
.Cost of Construction:$ 2,300 Utilities: _Sewer _Septic Building Height:
01NNf R/LESSEE:. `. CONTRACTOR:
Name JEREMY& JUSTINE THEISEN Name:
Address: 5811 BAMBOOD DRIVE Company:
City: `FORT PIERCE",,,_ ,< State: Address 355 PAL'MS�AV-
ZipCode ;3,49.82:,cd "'Fax: Ci FORT',PIERCE;;' .:, State: FL
ty;
I pp' 34982
Phone No 772 205-4759 Zi Code Faz:
E-Mail. " _ Phone No 772-201-8165
Fill in fee simple Title Holder on next page(if different E-Mail RODGERSCONCRETE@GMAIL.COM
from the Owner listed above) State or County License
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL-CONSTRUCTION.,.LIE:N LAW INFORMATION
DESIGNER/ENGINEER: xx 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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signat a of Owner/Lessee/96ntractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The f r oing inst nt was acknowledged before me The forgoing instru t was acknowledged before me
this day of 20/,q by t�hisdayof 20JVby
Per,onoaflly
person making s ate ent. �/aiofpjrscln making s atKnown OR Produced Identification sonally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
/'/1 6�'�
(Signature of (Signature of Not P State of Florida)
s::��+%?¢ AUDREY B.HUMPHREY %P REY �I� pHREY
on
Commission No "' n�:�°`: .OMMISS(0$1�1GG300817 I Commission No. =i°`� '`��; AUD
COMMIS ION#GG 300817
�`•,�Q� �; EXPIRES:March 6,2023 �.
EXPIRES:Ma
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•...... ' Bonded Thru Notary Pu fic Under Mfers
REVIEWS FRONT ZONING SUPERVISOR PLANS VEG arm 1uRTft:—_
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE-.
COMPLETED
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