HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 1 �� `,� Permit Number: 1
Building Permit Application
Planning and Development Services DEC 1 5 t�!f?
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resideo���x�'�i !
PERMIT APPLICATION FOR: Demolition
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: GARDEN CITY FARMS 05 35 40 E 50FT OF W 1 65FT OF S 1 50FT OF
TRACT 1 8-LESS S 25 FT-(31 ) (0 1 4 AC) (OR 2901-285ff0) �
Property Tax ID#: 2 - - - C2 LIN- (P N DD
SO SO -0 00 0 Lot No.
Site Plan Name: 2806, Avenue R Fort Pierce, FL 34982 Block No.
Project Name: Demolition structure 2806 Avenue R Fort Pierce, FL / St. Lucie County Code Enforcement
Setbacks Front_ Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Demolition of existing structure, removal of slab, removing all construction material, debris
CONSTRUCTION INFORMATION:
Additional work to be nerformed under t ispermit—check all appy:
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers FIGenerator Roof Roof pitch
Total Sq. Ft of Construction: Un )MO - SFt. of First Floor:
Cost of Construction:$ 2,500.00 Utilities: Sewer 1:1 Septic Building Height:
OWNERLESSEE: CONTRACTOR:
Name , Name: Scott Holmes
Address: Ulu ,- Company: Blue Goose Construction LLC
City: �V(2Zt_ , _.�___ State: F�- Address: 9901 Okeechobee Road
Zip Code: J3 X0(7 Fax: City: Fort Pierce State:FL
Phone No. 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 Florida CGC1517686
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: Name:Scott Holmes
Address:2806Avenue R Fort Pierce,FL 34982 Address:
City: 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 thepermit 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
comme work or r I
cor tice of Commencemen
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF }} u_C ,;` COUNTY OF St Luce
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this -A day of 7-D CLC. 20 0 by this 4 day of December 20_ by
Name of person making statement Name of person making statement
Personally Known >4 OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State o ida Cecffie Rosi F{ftnature of Notary Public-Sta e of Flor' CedlfaRose Hein
;—� NOTARY BLIC �. NOTARY PUBLI
Commission No. 1— 1—c� y�(p�p STATE OF Riftsion No.� SATE OF FLO
Commilt FF 44966 '� Cortm N FF244
Expires 6 9/2019 Expires 6/29/2 1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Planning & Development Services
J - Building & Code Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-1553 Fax 772-462-1578
m �
DEC 15 2017
PERMI sT-'i,4u
ASBESTOS NOTICE TO CONTRACTOR St. Lucie COUM ., FL
Date: 12/4/2017
Contractor Name: Scott Holmes
Business Name: Blue Goose Construction LLC
Address- 9901 Okeechobee Rd.
City. Fort Pierce State: FL
Zip Code: 34945
Re: Job Address: 2806 Avenue R Fort Pierce, FL 34982
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.
1,7111117
Signature & Date