HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGN ER/ENG INEER:Not
Name:
Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
-,e'Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
NaKe of person making
City:
`//
Zip: Phone:
Personally Known OR Produced Identification
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner Lessee/Co ntracto r as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA <A
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STATE OF FLORIDA cau
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COUNTY OF -1
COUNTY OF
The forgoing instrurgent was acknowledgeefore me
this day of 2a� by
The forgoing instr ent_Ta!, acknowledged before me
this �� day of � _MV --A 20 by
Names of person making statement.
NaKe of person making
gsstatement,
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Personally Known '" OR Produced Identification
Personally Known 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 )
Commiss9e of Fy�(i al)
Commission No. (Seal)
pyx r Natary u i
Suzette Ritch4e GG 1357MY 36
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UPERVISOR
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MANGROVE
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REVIEW
REVIEW
RE IEV1fa� R�9�fl�lzrzo2 REVIE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4/23/2019
C?CiNTY
F L o R 1 0 :`7
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential X
Address: 391 Nettles Blvd Parcel ID # 4502-501-0577-000-6
Property Tax ID #:
Site Plan Name:
Project Name,
DETAILED DESCRIPTION OF WORK:
Change out 3 ton 16 seer Carrier st cool split system 10 kw heater
CONSTRUCTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit –check all that apply:
_Mechanical _ Gas Tank _ Gas Piping — Shutters Windows/Doors
—Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 5000.00
Generator Root Pitch
Sq. Ft. of First Floor:
Utilities: Sewer Septic Building Height:
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OWNERAESSEE:
CONTRACTOR:
Name John Doyle
Name: Vance R Corbin
Company: Dodd Enterprises Inc
Address: 391 Nettles Blvd
City: Jensen Beach State:
Zip Code: 34957 Fax:
Phone No. 315-323-3358
Address: 1296 SE Industrial Blvd
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 neat page (if different
from the Owner listed above)
E -Mail doddenterpr ses@dodd.com
State or County License CMC1249958
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.