HomeMy WebLinkAboutBuildingPermitApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE
ACCEPTED
Date:
Permit Number:
b �
Building Permilt
Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
Residential ✓�
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address og 000 Z k1w k i
Old t;k -
,1
Property Tax ID #: Q j . �D
(� _ j�OO:
Lot No.
Site Plan Name:
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
/
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical — Gas Tank Gas Piping _ Shutters
Electric
Plumbing `Sprinklers
Total Sq. Ft of Construction:
pd
Cost of Construction: $ . / U(p i
OWNE
Name
Address: OOb �'
City:
Zip Code: jyc/ Fax.
Phone No.. wj - p 1/
E-Mail: 1 � b : i< A
Fill in fee simple Title Holder on n
from the Owner listed above)
State:
Generator
Sq. Ft. of First Floor;
`Ro
of
indows/Doors
Utilities: . Sewer _Septic
Building Height:
page (if different
.
i �io6�o of �nnc4rnniii.r, :� t7eiln .
CONTRACTOR: Name. Ray Reinhard
Company: HBS, Inc.
Address:722 3rd Place
City: veto rseacn State: FL
Zip Code: 32962 Fax: 772-778-3514
Phone No772-567-7461
E-Mai I tammyc@hbsglass.com
State or County License SCC131151281
-- ---- -- ---• •- r---- ... .........wnmiCncernenL is requlreq.
If value of HVAC is $7,500 or mare, a RECCIRDED Notice of Commencement is required.
Pitch
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION,
urL51GIVER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Phone:
BONDING COMPANY:
Name:_
Address:
City:
Zip:
Phone:
Not Applicable
Not Applicable
OWNER/ CONTRACTOR AFFIDVITa 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.
which Is Inc onflict with any applicable (Nome thatis
Association rules abylaws or andpcovenants that buildthe
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 IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF C CEMENT.'
of
STATE OF FLO
CVUIV I T Urr
Lessee/Cor�fractor as Agent for Owner
STATE OF F�nRlnn
COUNTY OFlndlan"ver
Holder
The fnr oing instrume t was cknowledge�i before me The forgoing instrum nt wa,s acknowledg before me
this day of 4O Cjby this 0_ day of n 20Q by
Name of person maki st ement.
Personally Known OR Produced Identification
Type of Ide tification
Produced?
Name of q�rson making state ent.
Personally Known OR Produced Identification
Type of Iden ification
Produced
(Sigr�'atureofNotary�ublic-Stet Florida v � vi f l-'
) (Sign ure of Notary Pu is -State o I ida )
Commission No. tiY Rrb* N(�qublic State of Florida'`.
Tarnmy C English mmission No. rp� Notaq&eState of Florida
My Commission GG 906987 Tammy C English
i EXOPOSs a e My CommS510n GG 906987
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
COMPLETED
DATE
��1v11v� 3urcnvi�uK PLANS VEGETATION"'
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