HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date -0_- J -7 - Permit Number:
,
VED
Building Permit Applicati n APR 9 2018
Planning and Development Services
ttil De artment
P FL
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 (Cou
e��jjl*county,
Phone: (772)462-1553 Fax: (772)462-1578 Commercial �E��I
Re$tde
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED]M PROVE M ENT LOCATION:
Address: OCA 41--2-2—S
Legal Description: SAND DOLLAR VILLAS CONDOMINIUM A- UNIT 223 AND LIND PRO RATA SHAREIN
COMMON ELEMENTS (OR 3633-2436)
Property Tax ID#: f 50-Q - (� 0 a o-? Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace Electric Water Heater )v r9
CONSTRUCTION INFORMATION:-
Additional work to be nerformed under this permit—check all appy:;
L]HVAC Gas Tank F]Gas Piping Shutters E]Windows/Doors
FlElectric 0 Plumbing R Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 600 Utilities: E]SewerE]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Stephen Jacobsen Name: Dale Hammond
Address: 2020 SW Aarofi Ln Company: For Him Plumbing
City: PSL State:FL Address: P 0 Box 1355
Zip Code: 34953 Fax: City: 3f-A&C-0 &60H State:FL
Phone No. - Zip Code: 34957 Fax:
E-Mail: Phone No. 772-342-8677
Fill in fee simple Title Holder an next page if different E-Mail: forHimplumbing@aol.com
from the Owner listed above) State or County License: CFC1428915
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: _XNot Applicable
Name: Stephen Jacobsen Nam e:DW�M
Address: Address: 909"-WLn
City: PSL State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:P O Box 1355 Address:
City: City:
Zip: Phone: 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 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 inspection. If you intend to obtain financing,consult with lender or an attorney before
co cing work or recording our Notice of Commencement.
Signa ure of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Licen a Holder
STATE OF FLORj, A STATE OF FLORIDAII ..
COUNTY OF a���'� COUNTY OF l�,a✓ -'P1
The forieg instrument was acknowledged before me The forgo ng instrum t s,acknowledged before me
this,?—'9 day of 201$by this
Name of persopAaking statement Name of person aking statement
Personal) Known R Produced Identification Personally Known AOR Produced Identification
Type of Identifica ion Typ o�fdentif atio
Produced Produced
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(Signature of Notary Publi - ate of Florida) (Signature of Notary Public-State of Florida)
Commission No. VG .�` "'% Sea LTER D PAYNE-Il 66 , �� � �LTER.D PAYNE-II
Notary utilic,-State of Florid' mmission No. P�B�� Se1
*.= Commission M;GG 24467 c. Notary Public-State of Flori a
• + - ; *e CommissionGG'2446y
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Comm::Ex ps Au 2520. 0' ;� • G
Bondedth opgh NalwnafNotacy.A Bondedt rough NaUonaf Not As in.
REVIEWS FRONPLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17