HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED E—
Date: 11/30/2018 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: 3870 N AtA Unit 702 Building 1 Ft. Pierce, FL 34949
Legal Description:
PropertyTaxlD#: �`1�3��05 (�o3rA_ QaWt{ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
AFTER THE FACT SHUTTER PERMIT SCANNED
BY
St. Lucie County -
CONSTRUCTION INFORMATION:
ltiona wor to e e orme under tispermit—checka apply:
0nn
HVAC MGasTank E]GasPiping Shutters ❑Windows/Doors
Electric Q Plumbing Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 2,000.00 UtilitiestSewer D Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: "
Name Doug Russell
Name:
Address:13930 Woodridge Path
Company:'s� +
City: Savage State: MN
Zip Code: 55378 Fax:
Phone No.952-210-7477
Address:
City: State:_
Zip Code: Fax:
Phone No.
E-Mail:dougrussell@mchsi.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License:
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
f-
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION-
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 concu�rency 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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
hi nneso-j-ct.
STATE 01" ORtDA
STATE OF FLORIDA
COUNTY OF H.MriQ;n
COUNTY OF
The f r�oing instrument was acknowledged before me
',dayof
The forgoing instrument was acknowledged before me
this'V bitcem624— .20 IS by
this _ day of .20_ by
Name of person making statement
Name of person making statement
Personally Known X OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced /
Produced
(Sign to a of N to ubl - o LEE ARLSON
(Signature of Notary Public- State of Florida )
r„
n i rl7dFaij s
Commission No. (SVAR'nesota
Commission No. (Seal)
20" 501 +6 My Commission Ez ires Janua 31 2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17