HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /312A I Permit Number: t)z o� - b
RECEIVED
'COUNTYSEP 2 p 2021
Building Permit ApplicatiQ.gciQCounty
Planning and Development Services 9
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 IMPROVEMENT LOCATION:
Address: 2207 RIVER HAMMOCK LANE
Property Tax ID#: 3404-313-0011-160-9 Lot No.9
Site Plan Name: Block No.
Project Name: RIVER HAMMOCK PROJECT-WATER INSTALL
DETAILED DESCRIPTION OF WORK:
SET WATER METER TO EXISTING SERVICE AND RUN 1" LINE TO HOUSE.TIE IN WITH COPPER ABOVE GROUND
LEAVING JOINTS EXPOSED FOR INSPECTION.
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical —)Plumbing
_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 MICHAEL CHIN-LOY Name:CITY OF PORT ST LUCIE UTILITY SYSTEMS.
Address:2207 RIVER HAMMOCK LN Company:
City: PORT ST LUCIE, FLORIDA State:_ Address:900 SE OGDEN LANE
Zip Code: 34981-3413 Fax: City: PORT ST LUCIE State:FL
Phone No.(772)607-0459 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.
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 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."
vAn&e-
Signature of ner/L ssee/Contractor as Agent for Owner Signature of Cofifractor7License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF LlGtic COUNTY OF <,e, LCCdt
The forgoing instrument a acknowledged before me The forgoing instrument was a knowledged before me
this ,day of ,so; ,ems 20� by this day of 20 al by
Name of person making state rent. Name of person making statement.
Personally Known V OR Produced Identification Personally Known 1,-' OR Produced Identification
Type of Identification Type of Identification
Produced Produced
IW4�v
(Signa re of orida (Sig ature of a ►c S t of Florida
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MARIELLY W BLANCO•GONZALEZ �i►r oiie;. MARIELLY W BLANCQADNI��a1LEZCommission N -• Notary Public-StatF �ljtrida Commission No. ;�: �: N Public-Sta ?l�ridammission#HH 068409 Commission#HH 068409
' My Comm.Expires Dec t,2FMW024 orf� My Comm.Expires Dec t
ssn. Bonded through National Nota Assn.
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DATE
RECEIVED
DATE
COMPLETED
3ev. 2/7/19