HomeMy WebLinkAboutBUILDING PERMIT APPLICATION}
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O
Date: SCANNtU Permit Number: �0 • ��l O
s r ? U EIVED
0
Building Permit Application 19 �01e
ment
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Other
permlttln9 , county
St.
t Lucie
Commercial Residential x
PROPOSED IMPROVEMENT LOCATION. .
Address: '5&og S pam s h Qi' Vtr P.A. ROr t Pla rc4- Ft 344 95/
Legal Description: Portofino Shores -Phase Three- PB 43-40 Lot 219 OR 2428-1188
Property Tax ID #: 1312-503-0025-000-6
Site Plan Name: Clarence or Violet Clarke
Project Name: Clarence or Violet Clarke
Setbacks Front Back: _
_ Right Side: Left Side:
15.1 kw PV Solar System roof top mount
Lot No, 219
Block No.
CO.N STRU C-TI O N i I N FO R M ATI O N
a
Additional work to be nertormed under this permit -check all that apply:
❑HVAC L_J Gas Tank Gas Piping _ Shutters a Windows/Doors
11 Electric 0 Plumbing U Sprinklers ElGenerator 0 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ _
S Ft. of First Floor:
Utilities: 0Sewer ElSeptic Building Height:
OWNER/LESSEE
CONTRACTOR:. t
,..,
Name Clarence or- Viyle+ Oay kc�
Name: be.Ani S
Address: 3(60Q SpGt� ni s j% (z,'yLe
Company: Coronado Custom Homes Inc
City: �py't P;Grcer State: FL
Address: 3001 Ceddra To -(-
Zip Code: 34951 Fax: —
City: 54LlDrjnq State: FL
Phone No. 772-462-6651
Zip Code: 33870 Fax: 863-453-4683
E-Mail: zins2ndson@gmaii.com
Phone No. 863-381-6083
Fill in fee simple Title Holder on next page (if different
E-Mail: operations.coronadosolar@gmail.com
from the Owner listed above)
State or County License: CVC56809 aQ$J3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLE'MENTAL.`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.
of Owner/ Lessee/Contractor as Agent for Owner Sign ure of Contr ctor/License Holder
1F FLORIDA STATE OF FLORIDA
'OF COUNTY OFF1- t&L?-b
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ping instrument was acknowledged before me
ay of M r-��A 20 1 �- by
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The forgoing instrument was acknowledged before me
this 2A- day of / . 20a by
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Name of person making statement
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Name of person making statement
Personally Known OR Produced Identi
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N R`
Known OR Produced Identification
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Type of Identification
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Produced
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(Signs of Notary Public- State of Florida)
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Commission No. (Sea
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REVIEWS
DATE
COMPLETED
Rev. 8/2/17
NING FRONT
COUNTER I ROEVI W I SUPERVISREVIEWOR I REVIEW I VEGETATI
EV EWON I SEREV EWLE I REVIEEWW