HomeMy WebLinkAboutBUILDING PERMIT APPLICATION� � 1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: 1/23/19 Permit Number. 1�d\' dsa `
• -' JAN 2 4 2019
-- Building Permit Applicati n
Planning and Development Services y, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TVPE:OWNER/BUILDER REMODEL - �e�aia to 01
PROPOSED INPROVEMENT LOCATION:
Address: 12314 Harbour Ridge Blvd, Palm City FL 34990
Property Tax ID q: 4426-600-0004-000-0 Lot No. LOT 3
Site Plan Name: 12314 Harbour Ridge Blvd, Palm City FL 34990 Block No. PL'Tmx
Project Name: GUMM REMODEL
DETAILED DESCRIPTION OF WORK:
;EEATTACHED /1 nn1 U�n D 1l9
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
—Mechanical Gas Tank _Gas Piping _Shutters
V Electric V/Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: 1,723 Sq. Ft. of First Floor: _
Cost of Construction: $ 50,000 Utilities: _Sewer _Septic
Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Christopher & Vanessa Gumm
Name:OWNERIBUILDER
Address: 12314 Harbour Ridge Blvd
Company:
City: Palm City State: _
Zip Code: 34990 Fax:
Phone No.609-226-5678
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:ChrisGumm@aol.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
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 INFQRMATION
= -
-
DESIGNER/ENGINEER:- — _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencingWqrk
or recording our Notice of Commencement.
1r
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA 1
S'l
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The fo,rggoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this al lay of --I Cu—) 20_L_5 by
this _ day of . 20_ by
Va/1ob't Gum r --.,
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Producedy/offAFL. jib
Produced
(Signature of Notary Public- State of Florida
(Signature of Notary Public -State of Florida )
Commission qs ^a% ELLENV) HHN
Otate of lorida-rvrvttllet§'1� Public
Commission No. Seal
(Seal)
_+ •= Commission N aG 270079
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