HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: LA 15 Permit Number: 15cm -(31 �3
3 RECEIVED APR`23 205
- � - - -- - SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie CnuntV
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: Alteration III
PROPOSED IMPROVEMENT LOCATION:
Address: 3451 W MIDWAY ROAD
Legal Description:
Property Tax ID #: 3403502-0192-00019
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.100
Block No.
DETAILED DESCRIPTION OF WORK: III
BUILDING 25 FEET OF NEW INTERIOR WALL FOR FILE ROOM
CONSTRUCTION INFORMATION:
iuona wor to e e orme un ert ispermit—c ec a apply:
11HVAC 0GasTank ❑Gas Piping _Shutters Windows/Doors
Z✓ Electric El Plumbing ❑Sprinklers I Generator 11 Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 2.200 Utilities:ll Sewer OSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name FLORIDA CENTER FOR RECOVERY
Name: MACK MATOS
Address: 3451 W MIDWAY ROAD
Company: MEL-RY CONSTRUCTION
City: FORT PIERCE State: FL
Zip Code: 34981 Fax:
Phone No. 772-229-0012
Address: 10967 S OCEAN DRIVE
City: JENSEN BEACH State: FL
Zip Code: 34957 Fax: 229-9440
Phone No. 229-9439
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: MACK@MEL-RY.COM
State or County License: 23630
iT vaiue of construction Is SZ500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: III
Name: JOHN CRESWELL PE#27002
AddreSS:."59 SE KUBIN AVE
City: STUART State:
Zip:34997 Phone:2s-oue
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
X Not Applicable
Address:
City:
Zip: Phone:
State:
BONDING COMPANY:
Name:
_Not Applicable
Address:
City:
Zip: Phone:
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
_ Signature of O(r✓ner/ Lessee/Agent
STATE OF FLORIDA STATE OF FLORIDA c i e
COUNTY OF 5-y _ COUNTY OF St.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi?-1Z) day of Q r . 20 � by thisQa day of q R C \ 20 by
V�.ac11c Y`.a�a5 ( w\d.c5
(Name of person acknowledging) (Name of person acknowledging)
S
Florida) (Signature of Notary Public- State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced r-Lr10 L. Type of Identification Produced T ` 0 L
Commission No.EE'q5"1C I (Seal)
Revised 07/15/2014
Commission No. � 6�6d6 (Seal)
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