HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11
Date: Permit Number: Q�l .0au5
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
PERMIT TYPE:
RRO__SED IIVIRR01/EMENT LOCATION ;.
Address: a 10
Property Tax ID#: 16Q- -fO 00ig 6- om-o Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF
CONSTRUCTION fNFQRIUlAT10N
Additional work to be performed under this permit-check all that apply:' /
_Mechanical _Gas Tank _Gas Piping _Shutters i/ Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1�'��, d d Utilities: _Sewer _Septic Building Height:
OWNER/LESSIE G
.-
Name ganald fili6arlsName:Ray Reinhard
Address: C_�/q . i Company:HBS, Inc.
City: O V_M State: Address:722 3rd Place
Zip Code:J 4 961
tt?? Fax:
City: Vero Beach State:FL
Phone No. R ql- K 33 - Zip Code: 32962 Fax: 772-778-3514
E-Mail: Phone No772-567-7461
Fill in fee sim a 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.
y •
SUPPLEMENTAL CONSTRUCTION' LliEN LAW IN�FOR�IVIATI'ON '
DESIGNER/ENGINEER: _Not'Applicable MORTGAGE COMPANY: —Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 JO E BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
1 H YOUR LENDE O AN ATTGJRNEY BEFORE RECORDING YOUR F NCEMENT."
Signature of Owner/ ssee/Contractor as Agent for Owner 4>gtlature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ._/.J'IGian &ILee COUNTY OF Indian River
The for oing instrument wa acknowledged before me The f oing instrum t s acknowled efore me
this day of F 20I by this day of 2 1 by
&17airl 9 6�7js,
Name of person making statement. Name of per on making A`=R
t.
Personally Known ✓ OR Produced Identification Personally Known duced Identification
Type of Identification Type of Identification
Produced Produce
(Signat f l,Vr, t - (Sign �f
iP"r" otary Pubic State of Florida "u otary P7btae of Florida
Commi is$t Tammy C English (Seal Com ss4`p '�`61. Tammysh ( al)
My Commission GG 906987 a My om906987
OF
or 0;dif Expires 01/23/2022 'sy�` off° Expires 2
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.