HomeMy WebLinkAbout5811 Hickory Dr Permit ApplicationAll 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
Address: (vl
Property Tax ID #: %� ) — 4 — W� Lot No.
Site Plan Name: Block No.
Project Name:
rll
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: a% (� Sq. Ft. of First Floor:
Cost of Construction: $ -3 Utilities: —Sewer —Septic
Windows/Doors
oof Pitch
Building Height:
Name a Name:
Address: r �5 Company:
City: State: AL Address: 1
Zip Code: Fax: City: �.
Phone No.Zip Code:
E-Mail:�,OcS{ tnac71/� .-Phone No
Fill in fee simple Title Holder on next page ( if different E-Maill(::Cknlicld
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.
DESIGNER/ENGI E _Not Applicable
MORTGAGE COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City: i State:
City: 4 v I L IState:
Zip: J Phone
Zip: " Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Mot 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
PO ED ON THE JOB SITE BEFORE THE FIRST INSPECTION. YOU INTEND TO OBTAIN FINANCING, CONSULT
WI H YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sin of Owner/ Lessee/Cont actor as Agent for Owner
Sig�a r f Contractor/License Holder
STATE OF FLORIDA
COUNTY
STATE OF FLORIDA
S G
OF
COUNTY OF
Thy forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
-dayof
this dayof P01i1va 207t by
this Chr 20LL by
C�rtti�r_.r 1 ki
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification x
Personally Known OR Produced Identificatior5_x
Type of I ification
Dr.V"C-5-
Type of Identification
Produc d 1uYl 6L Ic—
Produced t",
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(Sig ature of Nota ublic State of Florida)
NOTARY
(Signatur of Notary P is State of FloridW/,V1
Commission No. 676 3v U ' ( (Se pRyq Shant& R
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g fission No.�67 3 `0"�i �.}� ?STATE OF
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? Comm# GG300608
REVIEWS
FRONT
ZONING �N
EI RA
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19