HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i `l /
Date: 8/10/18 Permit Number: I �' V��`�
RECEIVED
S - J
AUG 2-0 2017
Building Permit Application
permitting Department
Planning and Development Services St.Lucie County
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: To Select from dropbox, click arrow at the end of line P00
PROPOSED IMPROVEMENT LOCATION:
Address: 1642 NW Bottonbush Circle, Palm City 34990
Legal Description: Harbour Ridge-Plat 1-Tallowood Village Lotl3(or 3370-1256)
Property Tax ID#: 4426-840-0014-000-1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace five fixed windows and one door on rear of home.
CONSTRUCTION INFORMATION:
Additional work toe Dertormed under this permit—check all appy:
aHVAC 0 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
❑Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction: $ $5400.00 Utilities: L I Sewer E]Septic Building Height: 1
OWNER/LESSEE: CONTRACTOR:
Name Carol Buyakowski Name: Ron Smith
Address:1642 NW Buttonbush Circle Company: Consolidated Building Corp.
City: Palm City State:FL Address: 7118 SE Osprey Street
Zip Code: 34990 Fax:None City: Hobe Sound State:FL
Phone No.914-475-7872 Zip Code: 33455 Fax: None
E-Mail:carolny45@aol.com Phone No. 772-215-3690
Fill in fee simple Title Holder on next page(if different E-Mail: toddfirstl@gmail.com
from the Owner listed above) State or County License: CGC053480
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: KNot Applicable
Name: Name:
Address: 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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Q6ntractor as Agent for Owner Signature of Con r r
STATE OFAOMBA-NJ&"�/Ci✓✓K STATE OF FLORIDA COUNTYOF Du tC�('YS� COUNTY OF tA 044 I �V
The forgoing instrument was acknowledged before me The f99r oing instru ent was ac ledged before me
this�day of U Sf 20 by this L' day of 20 by
POO BLya-owsK l ��N �� ��� _ S w\ � f
Name of person making statement Name of person making statement �—
Personally Known �,� OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificati rr/
Produced Produced L
(Signature of ry Pu c-State of (Signalure of Notary ublic-State of Florida)
NOTARY PUBLIC-STATE OF NEW YC RK ( (
Commission No.CI Pf-I,a95v3-2 N6904f*6215033 Commission No. I 1 (Seal)
Qualified in Dufchess Count
my Commission Expkes DeCembef 23, 021 RAL VEY"
.1 My CoMMI SIGN A FF2
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIOp, 'TUgJ*RE D&WGI;0QE
COUNTER REVIEW REVIEW REVIEW REVIEW + ""#tlTVIEW Iota
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17