HomeMy WebLinkAbout9523 Shadow Lane Permit RequestALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/11/2017 Permit Number:
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 Residential x
jjPERMIT APPLICATIONpry FOR: To Select from dropbox, click arrow at the end of line
Address: 9523 SHADOW LANE
Legal Description: MONTE CARLO COUNTRY CLUB - UNIT 2 - LOT 219 OR (3534-2677)
Property Tax ID #: 1334-502-0100-000-1
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No. 219
Block No.
A/C INSTALLATION: REPLACE LIKE FOR LIKE: SEER: 14/ GARAGE/ 5KW / 2 TON /
Additional work to pe nerTormed unser tnls permit— cnecK an apply:
HVAC 0 Gas Tank E]Gas Piping _ Shutters ❑ Windows/Doors
Electric F]Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 5605 UtilitiesSewer OSeptic Building Height: _
Name JOHN & KAREN EVANS
Address: 9523 SHADOW LANE
City: FT. PIERCE State: FL
Zip Code: 34951 Fax:
Phone No. 772-595-0265
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Roof pitch
Name: DON MIRANDA
Company: MIRANDA PLUMBING & AIR CONDITIONING
Address: 750 NW ENTERPRISE DRIVE # 100
City: PORT ST. LUCIE State: FL
Zip Code: 34986 Fax:
Phone No. 772-878-5123
E -Mail: alopez@mirandacompanies.com
State or County License: CAC1815486
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Not
Name:
Address:
City: State:
Zip: Phone,
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name, _
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: _
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name,
Address:
City: _—
Zip: Phone -
1 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 Ir1pgcJLon. If you intend to obtain financing, consu er,�rney before
comr(eric or recordi7-our Notice of Commencem
Signature of Owner/ Lessee/Agent ; c
STATE OF FLO IDA o
COUNTY OF
The forgoing instrument was acknowledged before n j %S
this day of . 20 by W•� •}pf -M
VWcc
(Namepf person acknowledging) 4 ,4 A31K.MS,
ature of Notary Public- State
Personally Known [---�OR Produced Identification
Type of Identification Produced
Commission No.F (Seal)
Revised 07/15/2014
Signature
STATE OF FLOR
COUNTY OF
The forgoing instrument was acknowledged before m
this day of 20 byc a 2
(Name of pgrson acknowledging
of Nrbtary Public- State of Florida )
Personally Known L- --"'OR Produced Identification
Type of Identification Produced
Commission No.–. Q7 v dI (Seal)
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS