HomeMy WebLinkAboutBuilding Permit Applicationi,
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:-, a`N i\G Permit Number:
RECEW'SE) JUL 292016
Building Permit Application
Planning and Development Services
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: Building
PROPOSED INPROVEMENT LOCATION:
Address: 3050 NW Radcliffe Way
Legal Description: Riverbend Plat Book 67 Page 36 City of Port St. Lucie, St. Lucie County, Florida
Property Tax ID #: 4425-703-0019-000-1 Lot No.14
Site Plan Name: Riverbend Block No.
Project Name: Riverbend
Setbacks Front 40.00 Back: 193.91 Right Side: 15.00 LeftSide: 15.00
DETAILED DESCRIPTION OF WORK:
New Construction-SFR Summer Kitchen
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit —check all apply:
OHVAC 11 Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
ZElectric ❑✓— Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 6000 . °a Utilities. — Sewer 1Z Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Standard Pacific of South Florida
Name: Scott Harala
Company: Standard Pacific of South FI GP, Inc.
Address:825 Coral Ridge Drive
City: Coral Springs State: FL
Address: 825 Coral Ridge Drive
Zip Code: 33071 Fax: 954-434-8840
City: Coral Springs State: FL
Phone No. 954-232-2290
Zip Code: 33071 Fax: 954-434-8840
E-Mail: Permits@brownspermitting.com
Phone No. 954-232-2290
E-Mail: Permits@brownspermitting.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License: CGC1506052
If value of construction is $2500 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
qRSILQ�)4 Signature of Owner/ Agent/ Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Broward COUNTY OF Rtn9�rn�
The forgoing instrume was acknowlecied before me
this ZZday of 6 20LJ by
Scott Harala
(Name of person acknowledging)
Q1__
(Signature of Notary Public- State of Florida )
Personally Known x OR Produced Identification
Type of Identification Produced
Commission
4�R{ref DENISE BROWN
Qo.•
U01 111111001on # FF IM
I'! . Expires November 4, 2018
Revised 07/15%2014
The forgoing instrument was acknowledged before me
this rz.Uayof 20®by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known x OR Produced Identification
Type of Identification Produced
Commission No.
Commission # FF 140607
Bonded Thru Troy Fain Insurance 800,W-7019
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