HomeMy WebLinkAboutBUILDING PERMIT APPLICATION{ If
All APPLICABLE INFO MUST BE COMPIt.`� FOR APPLICATION TO BE ACCEPTED / _ , (�
Date: (� -I q Permit Number: I �019� V
rLw
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
JUN 10 2019
PerStittin'9ieep omen
Building Permit Application SCANNED
BY
St. Lucie Coup
Commercial Residential X
PERMITTYPE:MODULAR HOME
PROPOSED IMkPROyEMENT LOCATION = -' s `` 15
Address: 6401 S Indian River DR
Property Tax ID #: 3412-123-0001-000-9
Site Plan Name:
Project Name: HEIZLER PERMIT
24' X 40'/39' MODULAR HOME INSTALL
vc s7- Llo
Lot No. 1
Block No.
Additional work to be performed under this permit— check all that apply: S
I
,Io�echanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric lumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 960
Cost of Construction: $i 24,75o
Sq. Ft. of First Floor: 960
Utilities: _Sewer _Septic Building Height:
OWNER%LESSEE
CQNTRACTOR'
y-'•t
Name Terry L Heizler Karen E HeizleR
Name: FITZGERALD JAMES
Address:6401 S Indian River DR
Company: DBK INDUSTRIES
City: FT PIERCE State: _
Zip Code: Fax:
Phone No.
Address: 6560 NW 13TH COURT
City: PLANTATION State: FL
Zip Code: 33313 Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail NANCYARMSTRONG61 @GMAIL.COM
State or County License CGC059461
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
I
�l1�PLT�N�'A�.�O�S"C�tUC'Clt3N
3:t�TV CAW IN'FORM,4TIF�N�,.
;�
DESIGNER ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY _Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Address:
City:
Phone:
Zip: Phone
OWNCK/ LUN 1 KALTUR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the Issuance of a permit.
no
'mit holder to build the subject structure
)variants that may restrict or prohibit such
any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
In accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WRII V/1,f l�T ll� I�w �u �.www�.
cognac a or uwner/ tes714
ntractor as Agent for Owner Signa of Contract6r/Urdn$e Holder
ST E OF FLOR ',G,n, ST E OF FLORICiA-\C UNTYOF UN C OE, �'l�/l �W_LjP
The for o nginstru e s cknowledg efore me The forgoing lnstru en as acknowledge fore me
this day of 20by this
day of 20y
rvame oT person maKing merit. �
Name of person making s tbment.
Personally Known OR Produced Identification
Personally Known OR
Produced Identification
Type of Iden n _._
Type of Ide Ion
Pro uced _
,VN
Produced
No1ery Public $We or Florida 4
t° Kimberly Ann Slaughter
My CanmJwiw GG 12375a
iy' Kimberly Ann Slaughter I
,- My CmissionGG 123750 4
oow Expires 0712412021
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(empires 0VM2021 4
ignature Ofotary Public eta m Hama)
( gnature offt6tiry Pub ic- state of Florida j
Commission No. (Seal)
Commission No.
(Seal)
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