HomeMy WebLinkAboutBUILDING PERMIT APP - FORT WALTONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
OU infilL i
° ' `" Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERM ITAPPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 6901 Fort Walton Ave FtI erce FL 34951
Property Tax ID #:1301-612-0195-000/9 LAKEWOOD PARK ADDITION unit 10 Lot No, 14
Site Plan Name: TALBOT RESIDENCE Block No, 127
Project Name: Custom Bridgeport 3 bed + den
DETAILED DESCRIPTION OF WORK:
3.2.2 SINGLE FAMILIY HOME
New Electrical Meter YES Second Electrical Meter NO
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit —check all that apply:
X_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors _Pond
X Electric X Plumbing _Sprinklers _Generator XRoof 6/12 Pitch
Total Sq. Ft of Construction: 2532 Sq. Ft. of First Floor: 2532
Cost of Construction: $ 2831900 Utilities: _ Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Kelly Talbot
Name: MARK MONTALTO
Address:
2703 Pineview Dr.
Company: PSL PROPERTIES
City: Ft, Pierce State: FL
Zip Code: 34981 Fax:
Phone No. 772-336-0050 E-
Address: 201 SW PSL BLVD
City: PSI State: FL
Zip Code: 34984 Fax:
Phone No 772-336-0050
Mail:
Fill in fee
from the
simple Title Holder on next page (if different
Owner listed above)
E-Mail pslprop I Pgmail.corn
State or County License CBC1263072
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: X Not Applicable
Name: PAUL WELCH INC
Name:
Address: 1984 SW BITMORE ST
_
Address:
City: PSL State: FL
City: State:
Zip: 34984 Phone 772-788-9888
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
BONDING COMPANY: X 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 a p ed on the ' bsite before the first inspection. If you intend to obtain financing, consult
with lender a torne byWre c(Immencing work or recording our Notice of Commencement.
signa Ire of wner/ Les a/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY Z5 LAC, Q
Sworn to (or affirmed) and subscribed before me of L Physical Presence or _ Online Notarization
this L day of 0! AZ213Lr , 207 t by
MALL Mryl 14In
Name of person making statement.
Personally Known OR Produced Identification
Ty I entification Produced
(Sig'rtawYe of Notary ublic-Sae of Florida)
0 ,'¢ SHANNON mrMER
Commission No. (Seal) .A MYCOMMgglpN#OG203869
r EXPIRES: JuOo N,1022
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