HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^
Date: SCANNED Permit Number: �1
BY
. :.� St Lucie County
RECEIVED
Building'Permit Application PP MAY 01 2J18
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting '
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1S78 Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
-PROPOSED IMPROVEMENT LOCATION, ' ..
Address: 4805 Christensen Road, Ft Pierce FL 34981
Legal Description: Christensen Acres, Lot 1
Property Tax ID #: 3405.600-0002.000-8
Site Plan Name:
Project Name: brinker
Setbacks Front Back: —
Right Side:'
Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK '
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pt t,-l-,r jp�i ni&+er v-(rr q pto( cte_a L �i�� �1-h �- c.t� o sel e.1bS(n3 g a4e.-S,
CONSTRUCTION]NFORMATION- _
i iona wor to e e orme under this permit —check a apply: -
[1HVAC Gas Tank Gas Piping Shutters ❑ Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft: of First Floor:
Cost of Construction: $ 2 (Wr9.� 00 Utilities: !Sewer E1 Septic Building Height:
'OWNER/LESSEE:' Y ..
.;CONTRACTOR`-
Name Ross Brinker
Name:. N/A
Company:
Address: 4805 Christensen Road
City: Ft Pierce State: FL
Zip Code: 34981 Fax:
Phone No. 772-528-0727
Address:
City: State:
Zip Code: Fax:
Phone No.
E-Mail: rossmissy@bellsouth.net
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencemen equirea.
SUPPLEMENTAL CONSTRUCTI';ON LIEN LAW INFORMATION:
DESIGNER/ENGINEER:_ Not Applicable
pp ble
Name:
Address:
MORTGAGE COMPANY: Not Applicable
Name: NSA
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: I
City: I
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone: I
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
/11 . ��
` V
Signature of owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 6 , L v t, %t
COUNTY OF
The forgoing instrument was acknowledged before me
4
The forgoing instrument was acknowledged before me
this �.day of . t �l . 20 1 by
this day of _ 20_ by
�y0e4-C
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced L
Produced
(Signature of Notary blic- StateWL-Na
IVENS
(Signature of Notary Public- State of Florida )
pE,nNNAMA121E
Commission No. c0W'MsSI�a��022023
g,2020
Commission NO. (Seal)
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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