HomeMy WebLinkAboutBuilding Permit ApplciationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address.
OF ORIDA q W&V
Address:
COUNTY OFSTATE
,
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Type of Identification
City:
Produced
City:
Zip: Phone:
(Signature of Notary Public- State of Florida )
Zip: Phone:
Commission No. ( e
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
commencing work or recording your Notice of Commencement.
Rev. 8/2/17
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Halder
STATE OF FLCOUNTY �� l r�
OF ORIDA q W&V
OFORIDA
COUNTY OFSTATE
,
The forgoing instru ent was acknowledged before me
this V day of U v 20jby
The forgoing iristrumVnt was acknowledged Pefore me
this day of ( 201& by
Name of perso aking statement
Name ofear remaking statement
V
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of I
(Signature of Notary Public- State of Florida )
Comm s Put"ic slate of "O" ISe
Commission No. ( e
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Suzette Ritchie
Expires
12112/20
REVIE� FRONT
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SUPERVISOR
PLANS
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ANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
1
E I
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/1112018 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34382
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 1195 Nettles Blvd
Legal Description:
Parcel ID # 4502-501-1382-000-9
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Change out 2 112 ton 15.5 seer Rheem st cool split system 8 kw heater like for like.
1 CONSTRUCTION INFORMATION:
HVAC Li Gas Tank
11 Electric 1:1 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 4500.00
s permit -- check allapply:
Gas Piping _ Shutters
]Sprinklers li Generator
S Ft, of First Floor: _
Utilities Sewer ElSeptic
Lot No._
Block No.
aWindows/Doors
0 Roof Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Gregory Jeltema
Address: 1195 Nettles Blvd
Name: Vance R Corbin
Company: Dodd Enterprises Inc
City: Jensen BeachState: FI
Zip Code: 34957 Fax:
Phone No. 616-560-2259
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address: 1256 SE Industrial Blvd
City: Port St Lucie State: FI
Zip Code: 34952 Fax: 335-3310
Phone No. 398-2344
E -Mail: doddenterprises@dodd.com
State or County License: CMC1249958
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.