HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a�a.�1 ao Permit Number:
RECEIVE®
•
. FEB 2 8 ?020
-- Building Permit Application
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT TYPE:SPECIALTY PERMIT
PROPOSED IM'PROVEMENT'LOCATION:
Address: 2400 RIVER HAMMOCK LANE
Property Tax ID#: 3404-702-0004-000-2 Lot No.4
Site Plan Name: Block No.
Project Name: RIVER HAMMOCK PROJECT-WATER INSTALL.
DETAILMDESCRIPTION OFWORK: : .
SET WATER METER TO EXISTING SERVICE AND RUN 1"LINE TO HOUSE AND TIE WITH COPPER ABOVE GROUND
LEAVING JOINTS EXPOSED FOR INSPECTION.
1"CO,_NSTRUCTIOUINFORMATION:
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ $544.00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR
Name DAVID HALL Name:CITY OF PORT ST LUCIE UTILITY SYSTEM.
Address:2400 RIVER HAMMOCK LANE Company:
City: FORT PIERCE, FLORIDA State:_ Address:900 SE OGDEN LANE
Zip Code: 34981 Fax: City: PORT ST LUCIE State:FL
Phone No.(772)940-9568 Zip Code: 34983 Fax:
E-Mail: Phone No(772)873-6400
Fill in fee simple Title Holder on next page(if different E-Mail UTILITYWATER@CITYOFPSL.COM
from the Owner listed above) State or County License 25597
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.
s S�UPP=LEMEN,TAEX,
QNASTR CTI,ONf= IEN.LA1h1/;IiN,FORMATCON;.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: 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 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 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 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOU LEN O AN ATTORNEY BEFORE RECORDING YOUR NOTIC F COMMENCEMENT."
Signature of Ow er/Lesse Contractor as Agent for Owner Signature of Cont ctor/License Holder
STATE OF FLO D STATE OF FLORIDA
COUNTY OF_ , C_Q�� COUNTY OF St Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 21-L day of 20 610 by this 04 day of February 20 go by
ie P Ape►I Lam/ Brad Macek
Name of person making sthitement. Name of person making statement.
Personally Known `/ OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
ignature of Notary Vubl g ure of No of to id )
r
arJEANETTE THOMPSON ,` �r,`,��-
� v�o•: y)Public-State of Flori ,o Y p e,,• J�ANETT THPSON
Commission No. mission No. :_. �= tar Pubii $
of Florida
• .•c Commission #GG 03706 •. ; Commission#GG 037064
My Comm.Expires Oct 14,2 20 ;N, o�c
Bonded t rou n National oar ssn •, of F� .
9 y e�rnrrn�`, Bondedth,' f100 I ( r
REVIEWS FRO UZU
N1)"';:—"ZO`N I P NS VEG E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVI
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19