HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED
Date: r' A. ) 3 - ' ^ A K
By
St Ludle
Buildi
Planning and Development Services
APPLICATION TO BE ACCEPTED
3 Permit Numbe/YVS-;;0VS&5'--
Linty RECEIVED
Permit Application MAY 01 2018
Building and Code Regulation Division Permitting Departmen,
2300 Virginia Avenue, Fort Pierce FL 34982 y�c i e County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial R ide%i
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION'-,
Address: 12786 NW Mariner Ct Palm City FL �4990
Legal Description: Mariner Village Harbour Ride Plat 4 Unit 22
Property Tax ID #: 4425 603 00334 0005
Site Plan Name:
Project Name: Clement
Setbacks Front Back:_
DETAILED DESCRIrPTION OF WORK:
install new generator on concrete pad 4 5 N
Side: Left Side: (o
Lot No.
Block No.
CONSTRUCTION INFORMATION:
f
itiona wor to e e orme un er t is per
1JHVAC Gas Tank ❑Gas
it— check
Piping
all
t=apply:
_ Shutters
❑ Windows/Doors
Electric 0 Plumbing
❑Spri
klers
❑ Generator
Roof Roof pitch
Total Sq. Ft of Construction::
S�Ftj of First Floor:
Cost of Construction: $ O?4; o00 •
Utilities: Sewer ❑ Septic
Building Height:
OWNER'AESSEE:
CONTRACTOR:
Name Patricia Clement
Name: Adam Sadow
Address:12786 NW Mariner Ct
Company: Winter Haven Electric, Inc
City: Palm City State.
Address: 7190 SE Federal Hwy #10
Zip Code: 34990 Fax:
City: Stuart State: FL
Phone No.
Zip Code: 34997 Fax:
E-Mail a
hone No. 772-283-1026
Fill in fee simple Title Holder on next - different
-Mail: Janetseach@gmail.com
from the Owner listed above) I
State or County License: EC0001889
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Ap licable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
I
Address:
City:
City:
Zip: Phone:
Zip: Phone: I
I
OWNER/ CONTRACTOR AFFIDVIT: Applicati8n 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 exerript from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls I, 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 tolobtain financing,. consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of
STATE OF FLO
COUNTY OF
r as Agent for Owner I Signature of
The forgoing instrument was acknowledged befc
this Zo day of A�%yi 1 2018 by
Name of person making statement
Personally Known OR Produced Identifi
Type of Identification
ry
Commission No. cW s MyCor
a,Q Expires
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Holder
STATE OF FLORA
COUNTY OF
me The forgoing instrument was acknowledged before me
this:26day of 1 2615 by
�cuy� Sc�cl o uy
-)r Florida
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Prodec d
(Signature of NItary
Public-
G 1s,o�-1 I Commission No.
1
�
NNotary Public State of Florida
' C n Pannebecker
M ComIssion GG 131021
j„�,�� Expires 08/0212021
REVIEW
UPERVISOR REVIEW PLANS I VEGETATIREVIEW
I S EV EWLE I MANGROVE