HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 10
s
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 x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: STOCKERS LOT 1
Property Tax ID#: 2405-720-00017000-7 Lot No. 1
Site Plan Name: Block No.
Project Name: HEMANG SHAS
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check a appy:
L�HVAC Gas Tank Gas Piping _Shutters Windows Doors
❑ a
Electric Plumbing Sprinklers ❑Generator Roof Roof pitch
Total Sq. Ft of Construction: SIn
of First Floor:
Cost of Construction:$ 600.00 UtilitiesSewer Septic Building Height-
Cost
,CONTRACTOR:
Name SHAS HEMANG Name: JOHN HYER
Address:3605 SLOAN RD Company: HYER QUALITY PLUMBING LLC
City: FT PEIRCE State: Address: 7501 ROBERTS RD
Zip Code: 34952 Fax: City: FT PIERCE State:FL
Phone No. Zip Code: 34952 Fax:
l
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CFC1427856
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN'LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:SHAS HEMANG Name:JOHN HYER
Address: Address: 3605 SLOAN RD
City: FTPEIRCE State: City: FT PIERCE State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:7501 ROBERTS RD 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 jobsite
before the fir "nspection. If you intend to obtain financing, consult with lender or an attorney before
commenci or or recording our Notice aCommencement.
Signatu of er/Le a/Contractor as Agent for Owner Signature of Contractor/License Holder
STA E OF FLORIDA - STATE OF FLORIDA
COUNTY OF COUNTY OF �"L(--
The for oing instr as acknowledged before me The forgoing instrument was cknowl adg d before me
this day of 20,n by this day of A) t 20U by
SHAS HEMANG JOHN HYER
Name of person making statement Name of person g statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature o Notary Public-S e of Florida
a) (Signature of Notary Public-State o r a)
Commission No. :' (5 ER IVU
PUBLIC Commission No. ( Ika NUNEZ
STATE OF FLORIDA at:va� NOTARYPLIBLIC
FF189093 §TATE OF FLORIDA
•SYNC191 _) lees 1/12-12019z. a C0
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SE%�' 1`�E E5`.i1AIlYtfi
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17