HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAWN INFORMATION:
L)4F
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
COUNTY OF
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
XNot Applicable
Address:
Type of Identification
Address:
City.
Produced
City:
.Zip: Phone:
Zip: Phone:
(Signature of Notary Public- State of Florida }
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 Count 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 your Notice of Commencement.
'- -
L)4F
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF + T_'
COUNTY OF
The forgoing inst u e t w s acknowledge efore me
this L day of �_ 2D Lby
The for oing instr rr�ent wa acknowledged efore me
this L day of IuL 2D by
Name of pens making statement
Name of perso making statement
Personally Known OR Produced Identification
Personally Known i OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida }
(Signature of Notary Public- State of Florida }
Co mmi5ea
r r Notary PublsC state or Ftort a
Com eal)
o r r� of e -s1 Florida
r Suzette 1�itchie
n GG 135736
' 3uzatte Ritchie
MY ccyr 1l�66i0f1 GG 135738
Comrn"t'
_ n. 1
Yj
E�
E.xpires
r �
REVIE S
G
SUPERVISOR
PLA
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/1312018 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 Commercial Residential X
Address: 402 Nettles Blvd
Legal Description:
Parcel ID # 4502-501-0588-000-6
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 4 ton 16 seer Carrier st cool split system 10 kw heater like for like
CONSTRUCTION INFORMATION:
Additional war to bene Orme under this permit— check a appy:
HVAC D Gas Tank E]Gas Piping _ Shutters a Windows/Doors
11 Electric ❑ Plumbing Sprinklers ElGenerator E]Roof Roof pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 4500.00
S. of First Floor: _
UtilitiesIn Sewer []Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name William Everett
Name: Vance R Corbin
Address: 402 Nettles Blvd
Company: Dodd Enterprises Inc
City: Jensen Beach State: FI
Zip Code: 34957 Fax:
Phone No. 772-215-4528
Address: 1296 SE Industrial Blvd
City: Port St. Lucie State: FI
Zip Code: 34952 Fax: 335-3310
Phone No. 39&2344
E -Mail: doddenterprises@dodd_com
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: CMC1249958
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.