HomeMy WebLinkAboutBuilding Permit Applicationti
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
COUNTY OF ,_
Address:
The ff oing ins er t has acknowledge4,pefore me
ZO by
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable .
Add rens:
T4gpe of Identification
Address:
Produced
City:
City:
(Signature of Notary Public- State of Florida )
Zip: Phone:
Commission No. (Seal)
Zip: Phone:
r7j, Notary Public State of �Florrida
Suzette Ritchie
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 tender or an attorney before
commencim work or recordinF, your Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Halder
STATE OF FLORIDA c r,�
STATE OF FLORIDA
COUNTY OF�
COUNTY OF ,_
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The ff oing ins er t has acknowledge4,pefore me
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Name of perso making statement
Name of pers making statement
Personally Known OR Produced Identification
Personally Known LOR Produced Identification
Type of Identification
T4gpe of Identification
Produced
Produced
(Signature of Notary Public- State of Florida }
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
Public State of RoMs
r7j, Notary Public State of �Florrida
Suzette Ritchie
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Suzette RItG to
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UPERVISOR
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
CONTRACTOR:
Date: 10/30/2018 Permit Number:
Name: Vance R Corbin
Address: 10701 S. Ocean Dr # 930
Company: Dodd Enterprises Inc
•
Address: 1296 SE Industrial Bivd
Building Permit Applicatio6
E -Mail:
Planning and Development Services
E -Mail: doddenterprises@dodd.com
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: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 10701 S Ocean Dr# 930
Legal Description:
Parcel ID # 4511-510-0130-000-7
Property Tax ID #:
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Change out 3 ton 14 seer Payne st cool pkg unit 8 kw heater like for like
CONSTRUCTION INFORMATION-
Additional work toe e orme under t—clockispermit a appy:
E]
E
aHVAC Gas Tank Gas Piping _ Shutters
windows/Doors
11 Electric ElPlumbing Sprinklers [I Generator
El Roof Roof pitch
of First Floor:
Total Sq. Ft of Construction: Sq nSewerE]
Cost of Construction: $ 3800.00 Utilities Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Robert Kauffman
Name: Vance R Corbin
Address: 10701 S. Ocean Dr # 930
Company: Dodd Enterprises Inc
City: Jensen Beach State: F1
Zip Code: 34957 Fax:
Phone No. 302-519-4071
Address: 1296 SE Industrial Bivd
City: Port St Lucie State: FI
Zip Code: 34952 Fax: 335-3310
Phone No. 398-2344
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: doddenterprises@dodd.com
State or County License: CMC1249958
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requwrea.