HomeMy WebLinkAboutPERMIT GALVINAll APPLICABLE INFO MUST BE COMPLETED
FOR APPLICATION TO BE ACCEPTED
Date: �J
Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia A venue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE, 41
PROPOSED IMPROVE ENT LOCATION,
Address:
Property Tax ID #: /yU l " [2! / '
/Q�y w V Lot No.
Site Plan Name:
Block No.1�`'
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 ?! Windows/Doors
— Electric _ Plumbing
_ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $Q
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name *' '0401VI rL
Name: Ray Reinhard
Address: 6100f aw
Company: HBS, Inc.
City: �. e'e'"
11
Zip Code: � Fax:
State: &
Address:722 3rd Place
City: Vero Beach State: FL
Phone No, Flo I 9
Zip Code: 32962 Fax: 772-778-3514
E-Mail: 4Qna/,//(n1sMwAe Aoet
Phone N0772'567-7461
Fill in fee ample Title Holde on next page (
if different
E-Mailtammyc@hbsglass.com
from the Owner listed above)
State or County LicenseSCC131151281
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:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip:
Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE
Name:
HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
city:
city:
Zip:
Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT9 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 NOTICEA*Af �NCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF F
COUNTY OF
Signature of Contractor/License Holder
LO STATE OF FLORIDA
. ✓l. (rLrI /(/2 LL., COUNTY OFIndianR��e
The fob oing instru was ac nowledg efore me
this day of 2 by
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Name of person making state ent.
Personally Known OR Produced Identification
Type of Identification
Produced
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DATE
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Name of person making
Personally Known 4Z
Type of Identification
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