HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: dune 1st, 2019 Permit Number:
� R�GELVE^D n
Building Permit Application Jug 1%
Building and Development Services Code Regulation Divsion permi.k .Po y�nt.
9St.�
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT TYPE: Demolition
PROPOSED IMPROVEMENT LOCATION:
Address: 5100 Russakis Road, Fort Pierce, Florida 34951
Property Tax ID#: 1315-121-0001-000-9
Lot No.
Site Plan Name: 5100 Russakis Road Block No.
Project Name: 5100 Russakis Road
DETAILED DESCRIPTION OF WORK:
Complete demolition r'4—fJ 44 o Vie
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction: J$ I Doo, Utilities: —Sewer _Septic Building Height:
.OWNER/LESSEE: CONTRACTOR:.
Name Glassman Holdings LLC Name:C.G.Taylor
Address:1000 South Federal Highway Company:L.E.B. Demolition&Consulting Contractors, Inc.
City: Boynton Beach, Florida State:_ Address:7 Harbour Islde Drive East 204
Zip Code: 33435-5614 Fax: City: Fort Pierce State:FL
Phone No.561-742-4910 - Zip Code: 34949 Fax: 772-461-2225
E-Mail:glassmandev@aol.com Phone No Office 772-461-4545/772-216-1286
Fill in fee simple Title Holder on next page(if different E-Mail iwreckn@aol.com
from the Owner listed above) State or County License CGC1519945/27215
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: '11, Not Applicable BONDING COMPANY: A Not Applicablel
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 Counter makes no representation that is granting a permit will authorize thepermit holder to build the subject structyre
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 JOB SITE BEFORE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FIN G, CONSULT
WITH YOUR LENDER O ATTO EY EFORE RECORDING YOUR NOTICE OF CO MENCEME
Signature of Owner/Lessee/Contractor as A t o wrier Signature of Contractor/License Hol r
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 1st day of June 20_ by this 1st day of June 20_ by
Name of person making statement. Name of person making statement.
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Personally Known xX OR Produced Identification Personally Known XX OR Produced Identification
Type of Identification11111111111 Type of Identification
1 I/
Produced NX X\ ///ii�
�1 A.BFB � Produced
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(Signature of Notary Public-St .FI ridM• . _ (Signature of Notary Public-St'at of FJ* I __10��N•,
IIGG 083308 '
Commission NO. GG 083308 9:dy�gaJ�tht� i��0�y� Commission No. GG 083308 *: ( aJr *=_
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//1/1!111 111111 �i� o'•.,!ic nde
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA } re SGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEV�//111/1111N101EW
DATE
RECEIVED
DATE
COMPLETED
iev.2/7/19
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