HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY: X Not Applicable
Name:
Address:
City:
Zip: Phone
State:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Name of persg�xmaking statement
City:
Zip: Phone:
Type of Identification
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 Count 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 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
ature of Contractor/License Holder
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this day of 20by
The fing instr rent was acknowledg efore me
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Name of persg�xmaking statement
Personally Known OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced
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Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2/27/2018
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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
Address: 2024 Nettles Blvd
Legal Description:
Parcel ID # 4502-501-0027-000-6
Property Tax ID #:
Site Plan Name:
Commercial Residential X
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Change out 3 ton 14 seer Payne st cool pkg unit 8 kw heater like for like
Lot No.—
Block
o._Block No.
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit– check all appy:
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L_IHVAC Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
aElectric Plumbing O Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: ___-
Cost of Construction: $ 3800.00
SFt. of First Floor:
UtilitiestSewer ESeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Kevin Roth
Name: Vance R Corbin
Address: 2024 Nettles Blvd
Company: Dodd Enterprises Inc
City: Jensen Beach State: Fl
Zip Code: 34957 Fax:
Phone No. 203-470-2765
Address: 1296 SE Industrial Blvd
City: Port St Lucie State: FI
Zip Code: 34952 Fax: 335-3310
Phone No. 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.