HomeMy WebLinkAboutSIGNATURE PAGESUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Not Applicable
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Not Applicable
'BONDING COMPANY:
Name:
Not Applicable
Address:
City:
City:
Zip: Phone:
Y
Zip: Phone:
Name of person making statement
1✓
OWNER/ CONTRACTOR AFFIDAVIT: 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 thepermit 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
commencing work or recording our Notice of Commencement.
Rev. 8/2/17
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF
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STATE OF
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COUNTY OF
The forgoing instr ent was ac cnowledged before me
The forgoing instr Tent wa acknowledged before me
this &L day of 2011 by
this day of &n 20JI by
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Name of person�naking statement
Name of person making statement
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Personally Known �` OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of identification
Produced
Produced
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
SEA TURTLE
MANGROVE
VEGETATION
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11[7/2017 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 352 Nettles Blvd
Legal Description:
Parcel ID # 4502-501-0548-000-4
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Change out 3 ton 16 seer Rheem st cool split system 10 kw heater like for like
Lot No.—
Block No.
CONSTRUCTION INFORMATION:
CONTRACTOR:
Name John Wendle
Name: Vance R Corbin
Additional work toe ne rmed under this permit –check
HVAC Gas Tank ❑Gas Piping
a
appy:
_ Shutters
Q Windows/Doors
OElectric E] Plumbing
Sprinklers
LJ Generator
L=1 Roof Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction: $ 4500.00
Utilities:
Sewer L ] Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name John Wendle
Name: Vance R Corbin
Address: 362 Nettles Blvd
City: Jensen Beach State: F:
Zip Code: 34957 Fax:
Phone No. 330-719-4184
Company: Dodd Enterprises Inc
Address: 1296 SE Industrial Blvd
City: Port St Lucie State: FI
zip Code: 34952 Fax: 335-3310
Phone Na. 398-2344
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
E -Mail: doddenterprises@dodd.com
State or County License: CMC1249958
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.