HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL (APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 09/27/2018 Permit Number: DO `
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Building Permit Application
iG ning and Development Services St C ce Dqpa
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uilding and Code Regulation Division
2300 Virginia. Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 .Fax: (772) 462-1578 ,. Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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5804 Balsam Drive, Fort Pierce, FL. 34982 !�
Address: «p a
Legal4 Description:
Property Tax ID #: 3402-610-0303-000-0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Remove exsisting entry cover and window overhang. Repair, replace, and 'connect`'the two overhangs
and rake them one continuous overhang/- cover as seen in plan.
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Additionalwork to be nertormed under this permit - cs ec a apply:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑ Electric ❑ Plumbing ❑Sprinklers ❑ Generator'Roof Roof pitch
Total Sq. Ft of Construction: 71 Sq. Ft. Sq- Ft. of First Floor:
Cost of Construction: Utilities: Sewer ❑Septic Building Height:
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Name Randall Slattery
Name:
Company:
Address:
Address:5804 Balsam Drive
City: Fort Pierce State:F�
Zip Code: 34982 fax:
City: State:
Phone No.561-373-4689
Zip Code: Fax:
E-Mail:randyslaftery7l@gmaii.com
Phone No.-
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:
.If value of construction is $2500 or more, a RECORDED Notice of Commencement is required..
Not Applicable
Name: Randall Slattery
Tess' 5804 Balsam Drive, Fort Pierce, FL 34982
Fort Pierce State:
Zip; Phone
SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 5804 Balsam Drive
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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
imp lovements 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
comknencine work or recording vour Notice of Commencement.
Signature er/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA-
COUNTY OF � 1�
COUNTY OF
Thelfor oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me '
thi 's day of ag Qk 20a by
this day of , 20_ by
Named person making statement
Name of person making statement
Perl ovally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identi`fi_c�atioi.
Type of Identification
P3ro�ed TT��
Produced
(Signature of Notary Public- ate of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
,00PayP��LASHAHNA INGRAM
Notary Public - State of Florida
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17