HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
s ■
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 t.
PERMIT TYPE: I ��
PROPOSED IMPROVEMENT LOCATION:
Address: 610 Y=rtt& ar eye e
Property Tax ID #: CJ�' �P- 04 ' / Lot No. U
Site Plan Name: Block No.L--
Project Name: Fw1p 1yc
DETAILED DESCRIPTION OF WORK:
a j I - I
I
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:
Cost of Construction: $ � C Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name
d
Name: Ray Reinhard
Address:
1 rec d
wf'erl
Company: HBS, Inc.
City: State:_.
Address:722 3rd Place
Zip Code: Fax:
Phone No. / M6 lQ
City: Vero Beach State: FL
Zip Code: 32962 Fax: 772-778-3514
Phone No772-567-7461
E-Mail: SO
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 NO F MENCEMENT."
L %
Signature of Owner/ Lessee/Contractor as Agent for Owner
Si nature of C ntractor/License Holder
STATE OF FLORIQASTATE
OF FLORIDA
COUNTY OF�J ��o
COUNTY 0 F Indian River
The f r oing instrurrAnt was acknowledged 4efore me
this day of 20 by
IC-i
The f9r§ping instriul9ent was acknowled before me
thi day of t.41 P by
Ada kall
l�
Name of person makings ement.
Name of pe son making st tement.
Personally Known .7011 Produced Identification
Type of Identification
Personally Known �OR Produced Identification
Type of Identification
Produced
Produced
diamonds
(Signature of Notary;. lid -.:St e, f Florida)
0gAy`P.o, Notary Public , of Florida
Commission No. > �_ TammyC(fl�hing
, oT My Commission GG 906987 F
�r fto4' Expires 01/23/2022
(Signature of Notary P ]lc- State f lori_da )
CoPublic State of Florida eal)
% TammyEnglish
` . My Commission GG 906987
REVIEWS
FRONT
ZONING
SUPERVISOR
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A URTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19