HomeMy WebLinkAboutBUILDING PERMIT APPLICATION_ I -
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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(1 Permit Number: 1
Date:
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SCANNED
• BY ED
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Planning and Development Services I
Building and Code Regulation Division Permltting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xx
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT'LOCATION: .
Address: 7124 Maidstone Dr I
Legal Description: MAIDSTONE (PB 43-11) 10T 94 (OR 4005-1437)
PropertyTax ID #: 3322-505-0103-000-0 I Lot No.94
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED. DESCRIPTION OF WORK:
Pour concrete for back patio 15x40 with 12x12 footing and 1 #5 rebar
Personal Use- stab for screen enclosure
ill
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CONSTRUCTION INFORMATION:
Additionalwor to e e orme un erit is permit— check a apply:
0HVAC Gas Tank []Gas Piping Shutters a Windows/Doors'
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Electric 0 Plumbing I Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: .
Cost of Construction: $ �d U Utilities: Sewer oSeptic Building Height:
OWNER/LESSEE: A
CONTRACTOR:,
NameMa U ."0
Name:
Address: / 2 P
Company: o Ti SLZ, c
City: 9 S C, State:
Address:-9, by
Zip Code: 3 _Fax:
City: A L State:- L(
Phone No. 2 Z. L' O 7-
Zip Code: 3 L(�Ef Fax:
E-Mail:
Phone No. 2 5 0 6 E
Fill in fee simple Title Holder on next page (if different
E-Mail: I_
from the Owner listed above)
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State or Co my License:
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If value of construction is $2St10 or more, a RECORDED Notice of Commence ent is required.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
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Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
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Address:
City:
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City:
Zip: Phone:
Zip: Phone: I
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 as 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, wads, 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
rnmmencine worbor recordine vour Notice of Commencement. n
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Signature of Owner L ee/ ac er
Signature of t ctor/lice se
STATE OF FLORIDA ppI
-STATE OF FLO A
COUNTY OF W (�, (� I
COUNTY OF
The forgoing instrument as cknowledge before me
The forgoing instr ent a c cnowledg before me
this day of 20" by
this day of 20� by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi n
Type of Identification
Produced
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4 �ttf
Produced
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(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida)
Commission No- �����
e I<A S. NII EN
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Commission No. �``o"' °gym -.,
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Commission S FF 115637
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My Commission Expires
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ZONING
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REVIEWS
FRONT
PLANS
VEGETATION
SEA TURTLE
COUNTER
REVIEW
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
/
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COMPLETED4
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Rev.8/2/17