HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
• R�CENED
Building Permit Application '/G p 5 ?021
Planning and Development Services Lucie
Building and Code Regulation Division perrnih,9 my
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT TYPE: Driveway
PROPOSED IMPROVEMENT LOCATION:
Address: 6803 Belleair
Property Tax ID#: 1301-611-0261-000-0 Lot No. 13
Site Plan Name: McMullen Block No. 112
Project Name: Dip Shit
DETAILED DESCRIPTION OF WORK:
Remove and Replace Driveway
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[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: $ 1800 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Patrick McMullen Name: Kenneth I. lippard
Address:6803 Belleair Ave Company:Lippard Construction Inc.
City: Fort Pierce State:_ Address: 1200 Driftwood Lane
Zip Code: 34951 Fax: City: Fort Pierce State: FI
Phone No. Zip Code: 34982 Fax:
E-Mail: Phone No 772-370-7548
Fill in fee simple Title Holder on next page ( if different E-Mail Lippardconstruction@comcast.net
from the Owner listed above) State or County License CGC1515384
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:
DESIGNER/ENGINEER: _ 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 OBT NN FINANCING, CONSULT
WITH,YOUR LENDER PR A y O R NOTICE QIF C M EMQW
ignat re of O er L see/ tractor as Agent for Owner ignature of Cont or icen der
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF CL- WC.�'G COUNTY OF cam-- LJGJ�
The foyp3ing instru ent was acknowledged before me The fo gm* g instrume t was acknowledged before me
this day of 20�by this J day of 20_Zby
Name of person making statement. Name of person making statement. �-
Personally Known OR Produced Identification Personally Known OR Produced Identifica ioTon
Type of Identification Type of Identificatio
Produced J� Ci Produced �/
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(Signature of Notary Public-TO f Florida) (Signature of Notary Public-State of FI rida) o
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Commission No. (Seal) O a�,� Commission No. (Seal) M m
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