HomeMy WebLinkAboutPalm Lake Park AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
C'J1oLulu-m :�N
00
o O-T Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial x Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: ST. LUCIE COUNTY
PROPOSED IMPROVEMENT LOCATION:
Address: 5000 Seagrape Dr. Fort Pierce, FL 34982
Property Tax ID #:
Site Plan Name:
Project Name: _
111110Mi 1{1 l
Palm Lake Park
Lot No._
Block No.
DETAILED DESCRIPTION OF WORK:
Installation of BCI Burke Basics, Nucleus #134-142083-1 Play Structure
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
_ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 23,118.82
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name St Lucie County
Name: Glen Hurley
Address: 2300 Virginia Ave
Company: Hurley Construction Inc.
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No. (772) 462-1944 E-
Address: 6026 Allen Street
City: Mount Dora State: FL
Zip Code: 32757 Fax:
Phone No (321) 231-6195
Mail: durettem@stlucieco.org
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ghurley3006@gmail.com
State or County License CBC1252079
IT vawe oT construction is Z5UU or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
' SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not App
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
x Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
x Not Applicable
State:
BONDING COMPANY: xti: Not Applicable
Name: _
Address:
City:
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements, yNr property. A Notice of Commencement must be recorded in the public records of St.
Lucie Cou d posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with leod-eAplin a0c$Jore commencing work or recording your Notice of Commencement.
t
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA,
, ,
COUNTY O
Sworn o (or aff►r ed nd subscribed bef me of f Physical Presence or Online Notarization
this day of 2&_
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification Produced
4(Sinature
of otary Public- State of FloriR29
State of Flon6a
nellCommission
No.(Seal)n GG 959609
2024
REVIEWS
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SUPERVISOR
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VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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