HomeMy WebLinkAboutBuilding Permit App - Pool House PassthroughAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
IL t- .
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial XX Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax. (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 12600 Harbour Ridge Blvd Palm City,FL 34990
Property Tax iD #: 4426-807-0000-000-7
Lot No.
Site Plan Name: South Shore Pool House renovations Block No.
Project Name: South Shore Pool House renovations
DETAILED DESCRIPTfON OF WORK:
Poo House passt roug per p ans
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
Mechanical Gas Tank Gas Piping Shutters Windows/Doors Pond
Electric Plumbing Sprinklers Generator Roof Pith
Total Sq. FtofConstruction: Sq. Ft. of First Floor:
Cost of Construction: $25,000.00 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
Name South Shore Villaee
Address: 133014W Ma lewood Lane
City: Palm Ci.tV _State: FL_
Zip Code: 34990 Fax: 772.336.1469
Phone No. 772.873.6016
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: Robert Dunlap
Company: Rubin Custom Homes
Address: 4253 SW High Meadows Ave
City: Palm CitV State: FL
Zip Code: 34990 Fax: 866-480-7498
Phone No 772-283-0553
E-Mail arubincustomhomes@gmail.com
State or County License 1529565
If value of construction is 2500ormore, 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 tender or an attornev before commenciniz work or recordine vour Notice of Commencement.
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519nature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Lt,cac�
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this M day of 20 7j by
Name of person making statement.
Personally Known _ OR Produced Identification
Typ entification Produced
(5ignatur of Notary Public- State of Florida)
Commission No. D (seal) �,►� Notaty Public Stets or Fionde
Robin 5uWvan
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