HomeMy WebLinkAboutPolhemus Permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginio Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
PERM IT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Commercial Residential
Address: 11001 S Indian River Dr, Fort Pierce, FL 34982
Property Tax ID %: 3532-50.3-0030-000-6 Lot Not & 3
Site Plan Name: Block No.
Project Name: Theresa Polhemus
DETAILED DESCRIPTION OF WORK:
Install
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters
Electric _ Plumbing —Sprinklers _ Generator
Total Sq. Ft of Construction: _
Cost of Construction: $ 46,850
Sq. Ft. of First Floor:
—Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameTheress Polhemus
Name: Ronald Heath
Address:11001 S Indian River Dr
Company: Max Guard Hurricane Windows LLC
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No.1 (845) 641-6510
Address:2253 Vista Pkwy, Ste 12
City: West Palm Beach State -FL
Zip Code: 33411 Fax:
Phone No 561-276-7100
E -Mail: polhemust@aol.com
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
E-MailRheeth@maxguardhnrricane.com
State or County License SCC131151738
If value of construction Is 52500 or more, a ReCORueu nonce of tammanve i w "Im .•
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:_
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application Is hereby made to obtain a permit to clothe work and installation as indicated.
I certify that no work or installation has commenced priorto the issuance of a permit.
51. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflictwith 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.
inconsideration 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 exemptfrom undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARMING TO OWNER: YOUR FAILURE TO RECORD A M0710E OF COMMENCEMENF MAY RESULT IN YOUR PAYNG
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AM
POSTED ON THE JOB SITE BEFORE THE RBST INSPECHON. IF YOU INTEND TO OBTAIN RMANCING, CONSULT
wTRYOUR LENDER AN ATTORNEY BEFORE RECORINK
YOUR NOTICE OFCOMMENCEMEM'
WA&L R/UME�
Signature ofContractor/License Holder
Vk-/J` "�
Signature of Owner/ Lessee/Contractoras Agent for Owner
STATE OF FL�tIgA
STATE OF FL
IDAAAM_3*WIN
COUNTY OF "
COUNTY v»'�Oy k\
The fpr�oing inst ent�edged before me
The ffQQrr$going Instff��ument wa acknowledged before me
this dayaf 2GL by
this kjdayoflI pro 2G1�by
1,-
'Awk a- Ci AkVN _
Name of person making statement.
Name of person making stat ment.
Personally Known OR Produced identification
Personally Known OR Produced identification
Type of Identification
Type of identification
P ced
Produced
_114M'IrY`
�C�f'
(Signature of Nota ubli on a
�— TA 1ViY BEER
(Signature of Notary P TAMMY BEER
��
.MY COMM GGI73091
Commission No. Ir
MYco NOGG1731WI
Commission No. exPIR e an 25 2022
PIREti ehruery 25.2022
.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.