HomeMy WebLinkAboutSLC Permit App (Demo)AL' APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Da t, Permit Number,
s
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2.300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 1491 NW Sweetbay Circle, Palm City, FL 34990
Legal Description: Harbour Ridge - Plat 9 -West Hammock Village Unit 2 (or 4103-871)
Property Tax ID #: 4426-804-0035-000-2
Site Pian Name: Thompson Residence
Project Name: Thompson Residence
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
(gyp 5`l U \` ^�c J� { 1r�.- '"1 LL C'�� ��-.`, [,L\ \ SQ GL1 /,��. • 1 Wj,.^.
_43
CONSTRUCTION INFORMATION:
djitjiona workto e e orme un er t is permit — c ec
ID FGas
a app y
Shutters
Windows/Doors
0HVAC Gas Tank
Piping_
0
Roof
11 Electric 1:1Plumbing
05prinklers
Generator
aRoof pitch
Total Sq. Ft of Construction:
5 Ft. of First Floor:
O D
Cost of Construction: $
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Ellen Thompson
Address: °1 ct �L ._
City:. Palm City State: FL
Zip Code: 34990 Fax:
Phone No. 410-382-4789
E -Mail: kcthompson1589@gmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Steve Rubin
Company: Rubin Custom Homes
Address: 4253 SW High Meadows Ave
City: Palm City
Zip Code: 34990
Phone No. 772-283-0553 Ext 2
E -Mail: recepbon1.rubincustomhomes@gMai I-com
State or County License: CGC1518190
Fax:
State: FL
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DE. 1NER/ENGINEER: Not Applicable
Namv.:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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, l do hereby agree that I will, in all respects, perform the work
in accordance with the approved pians, 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.
Signature of Own e r/Lessee/Co ntrbctor as Agent for Owner 59nature of Contractor/License Holder
STATE OF FLORIDA, STATE OF FLORIDA �
COUNTY OF-! L.fjC�C COUNTY OF! 1- ���
The f oing instrument was acknowledge fore me
this day of0144-1120�by
-- Gbell
(Name of pe n acknowledging)
J
(Signature of Notary Public- Stall of Florida )
Personatiy Known OR PrI Ica
Type of Identifi
R �FF 9992
.y {'SHmmisslon# 18
Commission�Caber4,202�Se�3Ls
Y, o. x iro Feinlnsurante
Revised 07/1512014
The forgoing instr went was acknowledge fore me
this,,; day of n 207,15—/by
(Name oacknowledging)
(Signature of Notary Publie-,btate of Florida )
Personally Known OR Produced Identification
Type of identification Produced
Commission No.I}
SHERR;KELLFy F�
�1,r �' Commission#FF999��
�Y�[rasoctober4,2420
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