HomeMy WebLinkAboutBuilding iPermit Application signed 4-26-21All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4-9-21 Permit Number:
RaC h
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FORResidential Home Demolition
PROPOSED IMPROVEMENT LOCATION:
Address: 27101 Okeechobee Road, F#. Pierce, Florida
Property Tax ID #: 3114-111-0001-000/7
Site Plan Name:
Project Name: Eaves Ranch
Lot No._
Block No.
DETAILED DESCRIPTION OF WORK:
Demolition of residential home - remove structure, pool deck and reg€ade area. Broken concrete to remain on site for reuse as rip rap by SFWMD
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors Pond
_ Electric — Plumbing
Total Sq. Ft of Construction: 2300
Cost of Construction: $ $2,300.00
Sprinklers _ Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height: 20 ft
OWNER/LESSEE:
CONTRACTOR:
NameSFWMD
Address:3800 Gun Club Road
City. West Palm Beach, FL State:
Zip Code: 33406 Fax:
Phone No.561-686-8800
Name: Donald R. Polanis
Company- Diversified Professional Services Corp.
Address:27915 Johnston Road
City: Dade City State: FL
Zip Code: 33523 Fax: 352-588-4393
Phone N0352-5M-2811
E-Mail:rtaylor@SFWMD.org
Fill in fee simple Title Holder on next page if different
from the Owner listed above}
i=-MailDpolanis@dps-corp.com
State or County License CGC061303
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required_
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Name:_
Address:
City: _
Zip:
INFER: x Not Applicable
State:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip; Phone:_
X Not Applicable
\Ji\iY:iTl i iV'i T.
MORTGAGE COMPANY: X Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: x Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as maicatea.
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public recd�rds of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain finaancjfhg, consult
*" I..r ,Y, n++r.rr.na. &% fnrn r^nmmonrinQ 1Airlrk nr rprnrdinF ynyr Nntire of Commence -Vnt.
wiu! iG"UC
-
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF �os�
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Not rization
this day of 12020 by
this 9,e day of �o.i/ 20Rby
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known 3;,,� OR Produced Identification
Type of Identification
Type of identification
Produced
Produced
AW'n`B:,I SANDRAL. POLANIS
1_0(Signature
of Notary Public- State of Florida)
Ignature of Notary Public 51;:E[on ission # GG 212026
My Comm. Expires Apr 29, 2022
Commission No. (Seal)
Commission No_ GG 2 ^ded th 1 Clonal Notary Assn.
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