HomeMy WebLinkAboutBuilding Permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `1�($�l`7 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential Y
PERMIT APPLICATION FOR: Other Fwttnola�;nh -a
PROPOSED IMPROVEMENT LOCATION:
Address: 1803 HAZELWOOD DRIVE, FORT PIERCE, FL
Legal Description: ESTATES OF LONGWOOD LOT 25(0.40ac)(or 696-350)
Property Tax ID#: 2433-502-0025-000-8 Lot No.25
Site Plan Name: Block No.
Project Name: OOSTDYK RESIDENCE FOUNDATION,REPAIR
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
-.DETAILED DESCRIPTION O.F'WORK:
REPAIR EXISTING FOUNDATION. NO NEW CONSTRUCTION WHATSOEVER. FOUNDATION
HAS SETTLED AND OWNER WOULD LIKE TO REPAIR THE SETTLEMENT BY UNDERPINNING
EXISTING SLAB.
CONSTRUCTION INFORMATION:
Additional work to be performed under tispermit—check all appy:
11HVAC E]Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers E Generator E] Roof Roof pitch
Total Sq. Ft of Construction: N/A S . Ft.of First Floor: N/A
Cost of Construction:$ 10800.00 Utilities:cnSewer Septic Building Height:
OWNER/LESSEE: - CONTRACTOR: - -
Name Name: PAUL KUHN
Address: 16003 HGZ.Zif-I WcOcl -Dr. Company: HERITAGE CONTRACTING SERVICES, INC
City: E+. 10i"c,9—c,9— State� Address: 3690 N US HWY 1
Zip Code: Fax: City: FORT PIERCE State:FL
Phone No. Zip Code: 34946 Fax: NIA
E-Mail: Phone No. 772-216-6612
Fill in fee simple Title Holder on next page(if different E-Mail: PAUL.K.HSC@GMAII COM
from the Owner listed above) State or County License- CGC1507158
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY•. x Not Applicable
Name: RICHARD A.JEMISON Name:
Ad d ress:PO BOX 5818 Address:
City: FORT PIERCE State: FL City: State:
Zip: 34954 Phone:.772-21-,-s623 Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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
commencing work or recor0ing your Notice of Commencement.
s
Signa re of Owner/Lessee/Contractor as Agent for Owner Signatur of Contractor/License Holder
STATE OF FLORIDA , STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrupieq1twas acknowledged before me The Fday
ing ins u nt was acknowledged before me
this 44 day of 20 .Iby this of 20 L by
1 n
(Name of person acknowledging) (Name of person acknowledging)
(IJ 111 1A _ l cf�-�' ! j///J�✓1 �Z' )
(Si nature of N ary�ublic- tate of Florida) J (Signature or/Nbtary Public-State of Florida)
PersKnow
onally R Produced Identification Personally Know�OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
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MY COMMISSION#FF 174772 ,. v"rg AUDPEY B.HUMPHREY
Revised 07/15/ 014 ; a EXPIRES:March 6,2019 P r ,: MY COM'r!ISSIUN#FF 174772
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"'•;;oc F�°.•` Bonded Thnu Notary Public Undenriters q;,•.Ll ,.•o; EXPIRES:March 6,2019
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