HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED H 1 2
Date: )-r , �� Permit Number:
Building Permit Application DEC 15 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Demolition
PROPOSED IMPROVEMENT LOCATION:
Address: 8740 Okeechobee Road Fort Pierce FL 34945
Legal Description. 23 35 39 E 330FT OF S 1 /2 OF SWI/4 OF SW 1 /4 OF SW 1 /4-LESS RD AND CANAL
RSM-(2.04 AC)(OR 3890-2977:3893-523)
Property Tax ID#: 2323-333-0003-000-2 Lot No.
Site Plan Name: Block No.
Project Name: Demolition of Structure located at 8740 Okeechobee Rd. Fort Pierce, FL
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
demolition of structure and removal of debris.
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CONSTRUCTION INFORMATION:
Additional work toe nertormed under tis permit-check all appy:
HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
aElectric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ Utilities:In Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Sunnier Palms Members Lodge Inc Name: Scott Holmes
Address:8800 Okeechobee RD Company: Blue Goose Construction LLC
City: Fort Pierce State:FL Address: 9901 Okeechobee Road
Zip Code: 34945-2369 Fax: City: Fort Pierce State.FL
Phone No.(772)468-8512 Zip Code: 34945 Fax: (772)468-4669
E-Mail: Phone No. (772)461-3020 ext 173
Fill in fee simple Title Holder on next page ( if different E-Mail: sholmes@bluegooseconstruction.com
from the Owner listed above) State or County License: State of FL CGC1517686
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
17
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
N a me:Sunnier Palms Members Lodge Inc N a me:Scott Holmes
Address:8740 Okeechobee Road Fort Pierce FL 34945 Address: 8800 Okeechobee RD
City: Fort Pierce State: City: Fort Pierce State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:9901 Okeechobee Road 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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement
f --
Signature of Owner/Lessee/Contractor Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Saint Lucie COUNTY OF Saint Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1 day of December ,20_ by this 1 day of December 20_ by
Scott Holmes Scott Holmes
Name of person making statement Name of person making statement
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Nota ublic-Sta f lori8lclbROSS Hein (Signature of Notary Public-Sta)e of Florida )
NOTARY PUBLIC
Commission No. 6/29/19 §TAt1E OF FLORIDA Commission No. 6/29/19 C ass Hein
Com►rdt FF244966 N PUBLIC
res 6/29/2019 STATE OF FLORIDA
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E)mire3
IVIAIVOROVE
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Planning & Development Services
Building & Code Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-1553 Fax 772-462-1578F--,
DEC 15 2017
PERM1IT71NG
St. Lucie Couclty, FL
ASBESTOS NOTICE TO CONTRACTOR
Date: 12/1/17
Contractor Name: Scott Holmes
Business Name: Blue Goose Construction LLC
Address: 9901 Okeechobee Rd.
City: Fort Pierce State: FL
Zip Code: 34945
Re: .lob Address: 8740 Okeechobee Rd Fort Pierce. FL 34945-2369
It is your responsibility to comply with the provisions of Section 469.003, Florida Statutes
and to notify the Department of Environmental Protection of any intentions to remove
asbestos when applicable in accordance with state and federal law.
.(-- ���'�,7- /'t/' ,
Signature & Date