HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 09 .
•
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 Commercial Residential X
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;PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
'PROPOSED IMPROVEMENT LOCATION:
'Address: 586 BEACH AVE PORT ST LUCIE,FL 34952
;Legal Description: RIVER PARK-UNIT 2-BLK 19 LOT 3(MAP 34/22N)(OR 2186-182)
Property Tax ID#: 6! 00 Lot No.3
Site Plan Name: Biock No. 19
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
SERVICE CHANGE -
CONSTRUCTION:INFORMATION:
Additional work to be performed under this permit—check all appy:
HVAC Gas Tankfn
❑Gas Piping OGenerator
Shutters QWindows/Doors
Electric 0 Plumbing Sprinklers EIRoof Roof pitch
Total Sq.Ft of Construction: Scl._Ft.of First Floor:
Cost of Construction:$2,400.00 Utilities:11 Sewer F�Septic Building Height-
OWNER/LESSEE: CONTRACTOR:
Name NANCY TAYLOR Name:
Address: Company: MR. ELECTRIC OF PORT ST LUCIE
City: PORT ST LUCIE State:FIL Address: 5994 NW BAYNARD DRIVE
Zip Code: 34952 Fax: City: State:FL
Phone No.772-875-6539 Zip Code: 34986 Fax:
E-Mail:nancy@nancytaylor.net Phone No. 772-777-5678
Fill in fee simple Title Holder on next page(if different E-Mail: mr.electric.psl@gmail.com
from the Owner listed above) State or County License: ER13015179
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: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:NANCY TAYLOR Name:
Address:566 BEACH AVE PORT ST LUCIE.FL 34952 Address:
City: PORTSTLUCIE State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name:
Name:
Address:5"4 NW BAYNARD DRIVE 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 inspectioi i. If you intend to obtain financing, consult with lender or an attorney before
c
nong work or-Lec, rdin our Notice of Commenceme
� "k) e � a
Signature of Owner/Lessee/Con r as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID i STATE OF FLORIDA
COUNTY OF I COUNTY OF �-�` ' .
The forgoing instr �t wa acknowledge before me The f rgoing instr ent as acknowfedgedbefore me
this day of 20 by this day of
e n r
Name of person making statemen Name of person making stateme
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Signature of Notary Public-Sta a of Florida) (Signa a of Notary Public-State-of rida)
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INGRAM
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Commission No. r — —�' j2°, ,`� Note %,"ic-State of Florida .
�'�'��`", Commission No. l "(Seal.
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REVIEWS I{ ONT�yy� Q,NINGfl SUS' ,,, °'R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER-<.o'7REVIEW�.. REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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