HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9/10/18 Permit Number:
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 CCltTll'1'tercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 5513 PALED PINES CIRCLE
Legal Description: HOLIDAY PINES S/D-PHASEI- LOT 9(MAP13112S) (OR1714-1151)
Property Tax ID #: 1312-500-0010-000-9 Lot No. 9
Site Plan Name: Block No.
Project Name: ROXANNE BACHMAN
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
LIKE FOR LIKE HVAC CHANGEOUT
3 TON 14 SEER 8 KW
CONSTRUCTION INFORMATION:
Additional work to orme un er t is permit — c ec a app y:
ff
HVAC Gas Tank Gas Piping E Shutters Windows/Doors
® Electric F� Plumbing Sprinklers ❑ Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 4638.75 Utilities: Sewer E Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ROXANNE BACHMAN Name: FREDERICK MILLER
Address: 5513 PALEO PINES CIRCLE Company: MILLER'S CENTRAL AIR
City: FT PIERCE State: FL Address: 673 SW CARTER AVE
Zip Code: 34951 Fax: City: PORT ST LUCIE State: FL
Phone No. 772-519-6939 Zip Code: 34983 Fax:
E-Mail: Phone No. 772-785-8080
Fill in fee simple Title Holder on next page ( if different E-Mail: OFFICE @MILLERSCENTRALAIR @AOL.COM
from the Owner listed above) State or County License: CAC058675
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zip: Phone:_
State
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone
Not Applicable I BONDING COMPANY
Name:_
Address:
City:
Zip: _ Phone:
Not Applicable
State:.
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Horne Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commen$ingoork or recording your Notice of Commencement. /
Siganatbrd df'Owner/ Lessee/Contractor as Agent for Owner
/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF a I I JL r COUNTY OF 1<5C L A Ag_
The forgoing instr ent was acknowiedg efore me
this day of aAll 20by
�aiy it -L Mi ay
Name ofp�er}�n making statement
Personally Known Xy OR Produced Identification
Type of Identification
Produced
The f r oing instrLgrerlt was acknowledge efore me
this day of 20by
Name of p n making statement
Personally Known OR Produced Identification
Type of Identifica ion
Produced
(Signature of Notary Public- State of FI DP OONS
��pN �5 i ature of Notary (Public- State of Florida I S AN
Commission No. ''`'`;:(See`�p �ficsf��,�� Commission No. -I lY E`Lgkgb� 45
20
� Op''N My5S3Q � 16 24
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATI i".t„ •• " E MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW EVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17