HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: *�''�,�. Permit Number:
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EIV��2015 RECE#'�/iEID
Bu it Application APR 13 2015
Planning and Development Services e County, FI.
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mobile home ,n
PROPOSED IMPROVEMENT LOCATION:
Address: 4155 N US HWY 1, FT PIERCE
Legal Description: 21 34 40 THAT PART OF S 730 FT OF SW 1/4 OF NW 1/4 LYG W OF US 1 (2.13 AC)(OR 3649-1987)
Property Tax ID#: 1 - - -2 f `� 1 y f p p(� 9— Q 06/ e) Lot No.78
Site Plan Name: Block No.
Project Name: COUNTRY COVE MHP
Setbacks Front 15 Back: 15 —Right Side: 15 Left Side: 15
DETAILED DESCRIPTION OF WORK:
NEW MOBILE HOME REPLACEMENT 2015
15'2X68
CONSTRUCTION INFORMATION:
Additional work to b e ertormed under this permit—check a apply:
ZHVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers FI Generator Roof
Total Sq. Ft of Construction: 1033 S.Ft. of First Floor:
ElCost of Construction:$ 2450.00 Utilities: LrJ Sewer Septic Building Height: 13'
OWNER/LESSEE: CONTRACTOR:
Name Country Cove MHP LLC Name: DWIGHT DOUGLAS
Address:49 SW Flagler Ave#201 Company: QUALITY MOBILE HOMES
City: Stuart State:FL Address: 4775 ELON CRES
Zip Code: 34994 Fax: City: LAKELAND State..FL
Phone No.772-252-4399 Zip Code: 33810 Fax: 863-606-5099
E-Mail: Phone No. 863-529-2370
Fill in fee simple Title Holder on next page( if different E-Mail: nancyarmstrong61@gmail.com
from the Owner listed above) State or County License: IH1025264
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
C - i
AL i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: NSA Name: N/A
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: NSA Name: N/A
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 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.
Signatu a of Own Agent/Lessee Signature of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF POLK COUNTY OF POLK
The forgoing in ment was cknowledged before me The forgoing instrument was acknowledged before me
this day of PLM 20 14 by this 20 day of DECEMBER 2014 by
DWIGHT DOUGLAS DWIGHT DOUGLAS
1�0e of person acknowledgin me of person acknowledging)
(Signature of No Public-State of Florida) (Signature of tkdary Public-State of Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced.F�oL Type of Identification Produced FLDL
Commis iQ{} m�: R _ q52 Commission No.
p G
= i 50,2015 r_._._�RMSTR
• >r° m :'a+.Pps EE059652
- S Janua�• 2015
Revise 15/2014 =�;• tPiRE
r+nri�allot
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE �r7
INITIALS
PLANNING&DEVELOPMENT SERVICES DEPARTMENT
BUILDING&CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I,the undersigned, am the owner of the following described property,
7 y!b?5 A ) u S P��
(Parcel IMILegal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St.Lucie County Land Development Code,I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
e
weer Name ' t)
t 9 -�l• /b�
Owner Signature Date
STATE OF FLORIDA,COUNTY OF J4, L.,Lt C� x
ACKNOWLEDGED BEFORE ME THIS a,s¢DAY OF ,T A n u Ce�!20 1 t�.
17 BY 1r(44 t r,,V i0 r e ss I e r WHO IS PERSONALLY KNOWN TO ME ✓/OR WHO HAS
PRODUCED AS IDENTIFICATION.
, k". .),- x e .c� 06 bo -ab S Act,M l�
SIGNATGRE OF NOTARY PUBLIC TYPE OR PRINT NOTARY
k�GOLfi CONMSSIONNUMBER'
�oP� Notary Public State of Florida
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`ti a My Commission EE 196066
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