HomeMy WebLinkAboutBUILDING PERMIT3
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
L i -
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
x
PROPOSED IMPRQVLMENT I.00ATIOI : !
Address: 141 1 FL 3�1 I SZ
Legal Description: Cn/cc"') wa'-'�6 Div' Z l C) s: _
Property Tax ID #: -qD7- C) - Lot No. C�
Site Plan Name:-Z-xC\,\k/ _� Block No. Z
Project Name: �.: L t'✓�^->
Setbacks Front Back: Z Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CON-STRUMN INFORMAT 1:
Additional work to e e orme m under this permit -check a apply:
❑ HVAC 13 Gas Tank ❑Gas Piping In _ Shutters ❑ Windows/Doors
❑ Electric 0 Plumbing ❑Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ -?A r �4 iLO
S Ft. of First Floor: _
Utilities:Sewer ❑Septic
Building Height:
OWNER/LESSEE:
CONMACTOR:
Name Z1 ♦ 6
Address: C.- 0C+ e4Y
Name: WAYNE THOMAS BURNETT
Company: FHIA,LLC
City: TO V 3[-CIC e- State:
Address: 3044 SW 42ND ST
Zip Code: 3L(� ?7` Fax:
City: HOLLYWOOD State: FL
Phone No.:)J:Z ~ � �� 9 -
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.
SUPAl C-,lq t1TALCONSTF,UCTIC)N LIEN LAW INFORMATION: I
GINEER: x Not App
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:30aa sw42ND sT
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: WAYNE THOMAS BURNETr.
Address:
City: HOLLYMOD State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 Commencemen m st be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financin milt with lender or an attorney before
commencing work or recording vour Notice of Commeft �\
Signature of caner/ Lessee Contra r as Agent for Owner
Sig re of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF . Lv
COUNTY OF
The forgoing instrument was acknowledged before me
this (pday of �� u5�— 20-A by
The f9j1oing instrument was qcknowledged before me
this day of T!'fi f� 20If by
\
00,
e /e- 7 6 /,
_
Name of person making statement
ame of person king statement
Personally Known Jw-`� OR Produced Identification
Personally Known OR Produced identification
Type of Identification
Type of Identification
Produc
Produced
LNUBEN BIRKINS
natur li' 'c id6Vte of Florida
{Signature o ry Public- State of Florida )
•., I £il�irlrlis5iorMe 1771722
Commissi
Expires Une 9, 2d21
Com ssio o. . i�"i' •� MIGUEL A � qpp
:r MY COMMISSION * GG095745
EXPIRES
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SE
VE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17