HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
•
OM
- 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
PERMIT TYPE:
PROPOSED IMPROV
Address:
Property Tax I D #:
Site Plan Name:
Project Name:
ENT LOCATION:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical
Electric
Plumbing
Total Sq, Ft of Construction/n: /
Cost of Construction:
Gas Piping
Sprinklers
Shutters
_Generator
Sq.First Floor:
Residential_
P
Lot No. r
Block No.
✓ Windows/Doors
Roof
Utilities: _Sewer _Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Cd -
Name: Ray Reinhard
Address: D
!
Company: HBS, Inc.
City: C�p`�
State:
Address:722 3rd Place
City: Vero Beach State: FL
Zip Code: Fax:
a
Phone No. �d „t- �� �-�w g
Zip Code: 32962 Fax: 772-778-3514
Phone No772-567-7461
/
E-Mail: OOT 4 0Valj& 60114
Ll.SC1'--CLP17
Fill in fee simple Title Holder on next page
( if different
E-Mailtammyc@hbsglass.com
from the Owner listed above)
State or County License SCC131151281
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name.
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER. _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
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 the permit 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTIC ENCEMENT."
Ign ure of wner/ Lessee/Contractor as Agent for Owner
Signature of Contr ctor/License Holder
STATE OF FLORIDA. /J
COUNTY OF / ICI ILY//l !(
STATE OF FLORIDA
COUNTY OF indian River
The fo oing instru t was acknowledged9 efore me
The fo ¢�ng instru b t was acknowledged fore me
this day of 20 Ley
this dday of 20y
efit.
Name of perso6 making 7OR
Name of erson making s�ta ement.
Personal) Known �' Produced Identification
Y
Personally Knowny OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
4V) b
V -
tam Id
(SI nature of Notarj Public- S yf9lof Florida)
(SI ure of Notar blic- SP& of Florida )
Notary Public State of Florida (Seal)
Tammy C English
My Commission GG 906987
CFIVA0
Commis' o N'd{ Notary Public State of Florida ($e'l)
-� F ,. ' anfirny ng h
� ',a �f i3c My Commission GG 90ii987 y
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SUPERVISOR
PLANS '`''C;1A'IdN
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`$E T�JRTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19