HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:4QqM'9-111y 1 to Permit Number:
SCANNED
3 BY
10 4 �5 St. Lucie Coun y
RECEIVED --
- Building Permit Applic tion
Planning and Development Services NOV 04 ^p+.9
Building and Code Regulation Division ST, Lucie Count
2300 Virginia Avenue, Fort Pierce FL 34982 y, Permltung
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentia
PERMIT TYPE: Addition
PROPOSED IMPROVEMENT LOCATION:
Address: 118 North Erie Drive, Lot 118
Property Tax ID #: 1433-210-0003-000-9
Site Plan Name:
Project Name: Tall Pines
DETAILED DESCRIPTION OF WORK:
Install driveway, carport and shed under carport
CONSTRUCTION INFORMATIONS
Lot No. 118
Block No.
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: 560 Sq. Ft. of First Floor:
Cost of Construction:$ 20,000. Utilities: XSewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR: '
Name Bedrock Tall Pines, LLC
Name: William J. Bushkie
Address: 650 5th Ave FI 1601
Company: B.A.C.H. Land Development
.City: New York State: NY
Zip Code: 10019-0015 Fax:
-Phone No.
Address: 3418 W. Arch St.
City: Tampa State: FL
Zip Code: 33607 Fax: 813-253-8899
Phone No 813-559-8555
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail tonyf@bach-development.com
State or County License CBC1260502
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.
SUPLEMENTALCONSTRUCTION LIEN.LAWINFORMATION:' '
DESIGNER/ENGINEER: _Not Applicable
Name: David w.Smith
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 6272 Alx,ou station Dr. Una tot
Address:
City: Zephyrhilis State: FL
Zip:33sa2 Phone613-78M374
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anscovenants 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 NOTICE OF COMMENCEMENT."
&1nuo",
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of ConYaEtor/LicensfHolder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF iiuishoroegh
COUNTY OF HHis miigh
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 7 day of odober 20_ 9 by
this 7 day of Deother
20_1�9 by
Susan Dennis -Agent
William J. Bushkie
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x
OR Produced Identification
Type of Identification
Type of Identification
Produced
'41- - Z"u
Produced
1)�
,, Z.&S
(Signature of No ary P
(Signature of Notary Publ
Sta•� ^f "^ '
:'M+t DONNALYNNRUSSELL
ry"•. DONNALYNNRUSSELL
Commission No._
.; MY 1361ON#GG360719
ommission No.
My1�SIOpI1fGG3807ty
'a• E%PiREB:July30.2023
EXPIRE$:July30,2023
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Rev.2/1/19