HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAND INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name: WAYNE THOMAS BURNETT
Address.
Address:
City: State:
City: HOLLYMOD State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:3044 SUV42ND ST
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 Commenceme t must be recorded and posted on the jobsite
sult with lender or an attorney before
before the first inspection. If you intend to obtain financ' \e--
commencingwork or recordingour Notice of Comm e t
zna 4A+n 14) IGP-�
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Signature —of Ownef Lessee/Contractor as Agent for Owner
Sig ur of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF %tv.t LV C'K
STATE OF FLORID
COUNTY OF AO;Af
The forgoing instrument was acknowledged before me
The for�oing instr m was acknowledgpf,before me
this Io day of 120A by
this day of 20_ by
Name of person making statement
Personally Known OR Produced Identification
Name of er making statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signs
Comm
o aryl
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•"_ MY COMMISSION # GGy qg
o L��1
peg« EXPIRESTuly 02, 20 1
(Signature lic-
•: A ERCADO
' ;'c MY COMMISSI
C sion No. = ' (�519�8CG095745
z . EXPIRES April 19.2021
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEWS
FRONT
ZONING
SUPERVISOR
COUNTER
REVIEW
REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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: J" Lf kF_-LAND
Legal Description: LAM-- wo o pIX�, Gt �oQ �-
Property Tax ID #: 136 { 0 a-`4i -G00 Lot No. 18
Site Plan Name: GV J%k N M cool-. Block No. Gq
Project Name: Gv �i ok-t
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
izE?I AGE i0 W k N Sows 1% 5 000e5 w/I rn POC S,' 4 Or Sr I f
CONSTRUCTION INFORMATION:
Xddiflofi5l work to e erformed un er this permit— check a apply:
�HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers MGenerator 0 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
—f
�), t
Cost of Construction: $ 5 s 3 Utilities: _ Sewer Septic Building Height: 5 __
OWNER/LESSEE:
CONTRACTOR:
Name
Name: WAYNE THOMAS BURNETT
Address:
Company: FHIA,LLC
City: 0.1-7� pl c'c0,, State:
Address: 3044 SW 42ND ST
City: HOLLYWOOD State: FL
Zip Code: -5L4915 j _ Fax:
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 $Z500 or more, a RECORDED Notice of Commencement is required.