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HomeMy WebLinkAboutCoastal Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 10/21/2020 g�� 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 x Residential PERMIT APPLICATION FOR:22 36 40 THAT PART OF N 265.62 FT OF S 665.62 FT OF SEC LYG E OF US 1 (3.13 AC) PROPOSED IMPROVEMENT LOCATION: Address: 7710 US Hwy 1, Port St. Lucie, FL 34952 Property Tax ID #: 3422-441-0004-000-8 Lot No._ Site Plan Name: Coastal Orthopedics Block No. Project Name: MRI Removal & interior Revovation DETAILED DESCRIPTION OF WORK: Removal of exisitng MRI machine and repairs as necessary to return building to match exisitng New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: Additional work to be performed under this permit–check all that apply: Mechanical Electric _ Gas Tank Plumbing Total Sq. Ft of Construction: Cost of Construction: $ OWNER/LESSEE: Name Address: -1),?) �t I r� � g) Gas Piping Sprinklers Shutters _ Windows/Doors Pond Generator _ Roof Pitch Sq. Ft. of First Floor: Utilities: — Sewer _ Septic Building Height: City ' a J �; State:: Zip Code: Fax:`°� ' Phone Nob. E -Mail: 1 Fill in fee simple Title Holder on next page ( if different from the Owner listed above) CONTRACTOR: Name. Christopher N Loy Company: CNL Building Contractors, Inc_ Address:336 SW Jackson Place City: Port St. Lucie Zip Code: 34986 Fax: Phone No 772-201-7163 E -Mail cnl2@bellsouth.net State or County Licen5eCBC039089 If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. State: Fl- If L SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: x Not Applicable Name: MORTGAGE COMPANY: x Not Applicable Name.- ame:Address: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address: City: Zip: Phone: BONDING COMPANY: Not Applicable Name: Address: City: 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 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 paying twice for improvements to your property. A Notice of Commencement must be recorded in the public records of St. Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attornev before commencing work or recording vour Notice of Commencement. Signature of Owr> r/ Lessee/Contractor as Agent for Owner I 5lgnature Ho STATE OF FLORIDA , STATE OF FLORIDA , COUNTY OF COUNTY OF --..,'r • L, --cu e - Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of _. Physical Pres c Online Notarization Physical Presence or Online Notarization this � ay of 2020 by this day of Oc4-uioer' , 2020 by Name of person making statement_ Name of person making statement. Personally Known .__ OR Produced Identification Type o eTd ntification Produced of Notary Publ Commission No. arida ),UME.O'SM W COMMISSION # GG 223394 30, 2022 Bonded 71n Not" PUM order Ift Personally Known OR Produced Identification Type of Identification Produced Ror±dict +v +ker�LiCer�� r�1 -'�'i :'0�`4':.. PAMELA S. CENK tature of Notar Public- t' ;oh�}� rurtI E ' State of r lonai y mission N GG 3 3 8 7 2 A ��3� l29 My 4omm. Mpires Jul 29, 2023 mission IV©_ _ _MaI'i REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.