HomeMy WebLinkAboutBUILDING PERMIT APPLICATION- -r
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6.a7 /% Permit Number: /701' 0,5`7`�
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Building Permit Application JUN2 7 2017
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED'IMPROVEMENT LOCATION:
Address: 13480 HARBOR RIDGE BLVD
Legal Description: PALMETTO VILLAGE BUILDING 5 UNITS B (OR 2519-1436)
Property Tax ID #: 4436-605-0040-000-0
Site Plan Name:
Project Name: 13480 HARBOR RIDGE BLVD
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
CHANGE TUB TO SHOWER. REPLACE VALVE. REPLACE TOILET AND LAVS SAME LOCATIONS.
CONSTRUCTION INFORMATION:
Additional wor to
OHVAC
e e orme un ert ispermit—c ec
Gas Tank Gas Piping
a apply.
In
❑ Windows/Doors
_Shutters
Electric
0 Plumbing Sprinklers
FiGenerator
Roof Roof pitch
Total Sq. Ft of Construction:
S'C Ft. of First Floor:
Cost of Construction:
p
$/J �r'�. (r� Utilities:Sewer DSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name GORDON NASH
Name: ROBERT LUDLUM
Address: 5101 HARVEY AVE
Company: AQUA DIMENSIONS PLUMBING SERVICE
City: WESTERN SPRINGS state: IL
Zip Code: 60558 o�Fax.
Phone No. �• r� / o�—
Address: 1651 SW SOUTH MACEDO BLVD
City: PORT ST LUCIE State: FL
Zip Code: 34984 Fax: 772-343-7418
Phone No. 772-344-8433
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: ADPA@AQUADIMENSIONS.COM
State or County License: CFC057526
it value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPP.LEMENTAI-CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 anorney before
commenia work or recordShs vour Notice of Commencement. _ _ / / /
as
STATE OF FL
COUNTY OFORIDA 5, ` / _ _ �� COUNTY OFORIDA (51 j „"
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day ofeJ 20 4Zby this 23 day of 1cNE 20 67 by
,4ffk1�G-/flow y w g Z' w-l'vz d����
(Name of person acknowledging) (Name of person acknowledging) _
(Signaturd'ofWc((Jr P i'(c- State II6f Flo1rida) (Signature of Notary Public- State of Flori �)
Personally Known=�toHLgceRc�Qd�n��f' �NDEZ personally Known ;' "'PINd1slBl AMidDE
Type of Identification - MY COMMISSION # GGQ Type of Identificatio P ic¢fi MY Comma 'inm u rGGW
KES enuary 26, 2021 ES January 26, 202t
Commission No. _ Commission No. (Seal)
Revised 07/15/2014
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