HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO) MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
PERMIT TYPE: Fence
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential X
Address: 6604 Lakeland Blvd Fort Pierce, FL
Property Tax lD #: 1301-6110392-000-7 Lot No, 9
Site Plan Name: Block No. 118
Project Name: Henry, Mike
DETAILED DESCRIPTION OF WORK:
Install - 4' black chain link fence, 1 - 4' wide and 1 - 5' wide pate
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical — Gas Tank — Gas Piping _ Shutters
— Electric — Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ _3356.
Generator
Sq. Ft. of First Floor:
_,,,,_ Windows/Doors
` Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Mike Henry
Name: Geary S. Adams Jr.
Address:6604 Lakeland Blvd
Company: Adams Fence 2 LLC
City: Ft. Pierce State: El
Zip Code: 34951 Fax:
Phone No. 260-667-8082
Address:1206 8th St
City: Vero Beach State: FL
Zip Code: 32962 Fax:
Phone No 772-999-2038
E-Mail elizabeth(c)adamsfencecompany.com
E-Mail: n/a
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License 27078
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 LIEN LAW INFORMATION: I
Ut5ICiNtK/tNCiINttK: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
,,,Not Applicable
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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License-older
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF �a 1 LA_. eA_
COUNTY OF Indian River
The forgoing instrument was acknowledged before me
I 11*R day
The forgoing instrument was acknowledged before me
this of � 20 LQ by
thistth day of May 12020 by
ed cu l�
Geary S. Adams, Jr.
Name of persbn making statement.
Name of person making statement.
gs
Personally Known '✓ OR Produced Identification
Personally Known �_ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
A
( ignature of rtary Public- State of Florida)
JCommission
(Igriatur of otary Public State of Florida)
No. �i '10003% (Se jr C
1 Q 0xk No, 908037
Notary
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ublic - State of Florida a° •»�4 Notary Public -
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