HomeMy WebLinkAboutDearborn - 9550 S. Ocean Drive, U-210All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
i7 Permit Number:
O
Planning and Development Services Building Permit Application
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce Ft 34982 Residential x
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: pearborn, Luther H. and Barb
PROPOSED IMPROVEMENT LOCATION: ara L
Address: 9550 S. Ocean DR., U-210
Property Tax ID #: 4502-601-0014-000-9
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK.
water line leak in slab, kill water line and run overhead
New Electrical Meter. Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
—Mechanical _ Gas Tank —Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 2250.00
OWNERAESSEE:
Lot No._.
Block No.
_ Shutters -Windows/Doors _ Pond
— Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
Name Dearborn, Luther H & Barbara
Address:9550 S Ocean Drive, U-210
City: Jensen Beach State: 'FL
Zip Code: 34957 Fax:
Phone No. 209-824 -1799
E-Mail: barbdearborn@hotmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: Cecil L Marion
Company: Pipe -Connection, Inc.
Address:2501 SW Baer Street
City: Port St. Lucie State: FL
Zip Code: 34953 Fax:
Phone No (772) 919-2757
E-Mail pipeconnection@yahoo.com
State or County License CFC033824
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 attorney before commencing work or recording our Notice of Commencement.
r ature of owner C n r � g / Lessee / o t actor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA i
STATE OF FLORIDA
COUNTY OF
COUNTY OF tC1E'rr
Sworn to (or affirmed) and subscribed before me of
Sworn (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
_/Ph sical Presence or Online Notarization
this 5 day of —1-Anf tkA M 202$ by
this.�day of 2020yby
Name of person making statement.
Name of person making statement.
Personally Known d OR Produced Identification
Personally Known LOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature N r i�- StateL��j@�JI�4�itON
(Sig ture of otary Public- ate of F1 ids . Jean Kelley
M+ tiny Commission
Com fission No 94 ( Expires 12116t2
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2tommissio No. "' �' ` EXPIRES: Oct of�88j)023
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Rev.5/6/20