HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST
iBE�COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: ^, I S Permit Number:
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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 X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 6560 SOUTH FEDERAL HIGHWAY Bldg. B Port St. Lucie, FL 34952
Legal Description:
Property Tax ID#: 3415-503-0003-000-8 Lot No.
Site Plan Name: Block No.
Project Name: TCBA Door Replacement
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: v
Replacement of two (2) exterior out swing entry doors 4p_n IFn:'F�
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit—check a appy:
I JHnVAC Ei Gas Tank E]Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 600.00 Utilities:Sewer E]Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name Treasure Coast Builders Asociation Name: Ronald Kirchman II
Address:6560 SOUTH FEDERAL HIGHWAY Company: Kirchman Construction Co.
City: Port St. Lucie State:FL Address: 2597 S E Delmar Street
Zip Code: 34952 Fax. 772-461-4054 City: Stuart State:FL
Phone No.772-336-8882 Zip Code: 34997 Fax: 1-772-283-1570
E-Mail:maddie@treasurecoastba.com Phone No. 1-772-260-0649
Fill in fee simple Title Holder on next page(if different E-Mail: ronnie@kirchmanconstruction.com
from the Owner listed above) State or County License: CGC 048554
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 Commencement must be recorded and posted on the jobsit
before the first inspection. If you inten o obtain financing, consult with lender or an attorney befor
commencing work or recordit),gyoukNotice of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder rt>rC
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2T'qday of int A Y 201_by this V day of A / }` 20 �rby
I co e,%, F rc% c%J
(Name of Orson acknowledging) (Name of person knowledging)
:::7 C-,L4Y��
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(Signature of N66ry Public-State of Florida) (Signature of N&ry Public-State of Florida)
Personally Known_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No. """"'� TANYA FRANCHI
nrr� TAP 94 ANCHI �,•iPar P�s�,;; ' eal
Watary�Public-State of Florl
Notary Public-State of Florida ;.; My Comm.Expires Dec 13TO 4;JJ ,20
9n17•* `o�� Commission#FF 48801 my euneirp.Exp'FOG DOC 13- Commission FF 48.01
:�FOF.FtoP`��
Revised 07/15 b" Bonded Through National Notary As
;;l Bonded Through National Notary Assn.
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DATE
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