HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
U
DESIGNER/ENGINEER:
Name:
Address:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
COUNTY OF ' `
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
X Not Applicable
BONDING COMPANY:
Name:
XNot Applicable
Add ress:
Type of Identification
Address:
Produced
City:
City:
(Signature of Notary Public- State of Florida )
Zip: Phone:
Commission No. eal)
Zip: Phone:
"XT 1-i* Notary Public Ststa of Fioficta
' suzette Ritchie
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 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.
, It (t_�_
a6c:��e
U
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDASTATE
OF FLORIDA
wet
COUNTY OF '. y
COUNTY OF ' `
The for ping instr ent was acknowledge before me
this day of 20 by
The for ging instru n was acknowledgbefare me
this day of 20 by
Name of person aking statement
Name of personmaking statement
Personally Known OR Produced Identification
Personally Known L-"" OR Produced Identification
Type of identification
Type of Identification
Produced
Produced
Jut �J�� X ix
(Signature of Notary Public- State of Florida )
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. eal)
rU N=ry public State of Florida
Ritchie
"XT 1-i* Notary Public Ststa of Fioficta
' suzette Ritchie
c
RE li n
My Commission 1
FI VIV i2l29 I
SUPERVISOR
Ex firms 121121
PLA G T
21
MANGROVE
I
REVIEW
REVIS f
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2/27/2018
Permit Number:
•IJ4A
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
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 565 Nettles Blvd
Legal Description:
Parcel ID # 4502-501-0751-000-0
Property Tax ID #: Lot No.
Site Plan Name:
Project Name:
Setbacks Front
Back: Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK: I
Change out 2 ton 16 seer Rheern st cool split system 5 kw heater like for litre
CONSTRUCTION INFORMATION:
Additional work toe�je orme under this permit —check a' appy:
HVAC i.J Gas Tank Gas Piping _ Shutters Windows/Doors
FlElectric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 4500.00
S Ft. of First Floor: _
Utilities:- Sewer I- Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name James Moran
Name: Vance R Corbin
Address: 565 Nettles Blvd
Company: Dodd Enterprises Inc
City: Jensen Beach State: Fl
Zip Code: 34957 Fax:
Phone No. 508-237-2785
E -Mail:
Address: 1296 SB Industrial Blvd
City: Port St Lucie State: FI
Zip Code: 34952 Fax: 335-3310
Phone No. 398-2344
E -Mail: doddenterprises@dodd.com
Fill in fee simple Title holder on next page [ if different
from the Owner listed above)
State or County License: CMC1249958
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.