HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/6/17 Permit Number:
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Building Permit Application DEC 1 1 2057
Planning and Development Services P,F;"ff ITTiNG
Building and Code Regulation Division St. Lucie i:o!;a}, FL
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: 1812 Hazelwood Dr Fort Pierce
Legal Description: ESTATES OF LONGWOOD E 1/2 OF LOTS AND ALL LOT 10 (0.53 AC) (OR 4048-1350)
Property Tax ID#: 2433-502-0010-000-0 Lot No. 9/10
Site Plan Name: Block No. N/A
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: l
Remove and relace damaged ecooncrete in front of garage(driveway)
3000PS14"thick / �p� 'z �f r' (C }�5 S
CONSTRUCTION INFORMATION:
Additional work to be e Orme un er t ispermit—c ec a app y:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$_mac` (b Q� Utilities: F]Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Elite Homes of the Treasure Coast LLC Name: ,lose Vides
Address:1660 NW Federal HWY Company: JosB Concrete Perfection
City: Stuart State:FL Address: 383 SW North Shore Blvd
Zip Code: 34994 Fax:None City: Port St Lucie State:FL
Phone No. Zip Code: 34986 Fax: N/A
E-Mail:None Phone No. 772 812 5066
Fill in fee simple Title Holder on next page(if different E-Mail:josbconcreteperfection@hotmail.com
from the Owner listed above) State or County License: 25230
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:N/A Name:N/A
Address: Address:
City: State: City: State.
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I 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, 1 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 ecording your Notice of Commencement.
Signature of Owner/Les e s gent for Owner Signature of Contr o License Holder
S T ATE OF FLORii3A ST AT E OF FLORIDA
COUNTY OF COUNTY OF uclE
The forgoing inst ment was acknowledged before me The forgoing instru m
ent was acknowledgeAbefore e
this 1day of _,20�J by this�day of 20ll by
Name of person making statement Name of person maKmg statement
Personally Known OR Produced Identification I,/_ Personally Known OR Produced Identification_L/—/
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florlda) (Signature of Notary Public-5 to of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE I MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17