HomeMy WebLinkAboutSUBMITTED PAPERSALL APPLICABLE INFO MUST BE COMPI 1. 'D FOR APPLICATION TO BE ACCEPTED r
Date: SCANNED
SCANNED Permit Number: �"��4
BY
St. Lucie County
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 zX
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 21 / a y c/S-0 S7
Legal Description: 2 / )D -(,) q/5 `f
Property Tax ID #:� ��� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Aaamonal worK tO De erTormea unaer tnis permit- cnecK a
11HVAC Gas Tank ❑Gas Piping
Electric Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
tnaiappiy:
11 _ Shutters
❑ Generator
S�Ftj of First Floor: _
Utilities: L_I Sewer 11 Septic
Windows/Doors
Roof
Building Height:
fry '�41
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Name �'okij QAvll/-/e
Name: -'r-Sys-'"
Address: a►lo !✓ ySrl
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Company: Ch,9,,-e(. 6P ��on,l� Gcc
City: .",
State:/_C
Address: sG% A%2 fee 124 M e =d - c
Zip Code: Fax:
City: "PSL Stater
Phone No.
Zip Code: 39rs-3 Fax: �» z yPf r33
E-Mail:
Phone No. 722 y6 e 4�l 9 f/
Fill in fee simple Title Holder on next page (if different
E-Mail: /S/.,trA-/ crXll 4cG. C Pam_
from the Owner listed above)
State or County License: e°fC /Y z 757c-/ /
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone:
T
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
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 an attorney before
commencing work or recording your Notice of Commencement.
tgnature of Owner/ Agent/ a see
STATE OF FLORIDA
COUNTY OF �XA�
The fArgping instr ent cknowledged before me
,thi day of 20 14 by
�n� a__ Y)
of person acknowledging)
(Signature of Notary Public -
Personally Known . ' OR
Type of Identification Producei
Commission No.
Florida
DAWN MILONE
Nc(Sq,O�blic - State of Florida
My Comm. Expires Mar 22, 2017
Sign re of Contractor/Li-cense'Hotdift
STATE OF FLORID
COUNTY OF_!�o�
The f2 ging instrui ent &acknowledged before me
thiso/ ( day of 20_1& by
�-
of person acknowledging.)
(Signature of Notary Public-- State of
Personally Known OR ProdUced Identification
Type of Identification ProducedL_c
Notary Public -State of
A..
Qn ldmd Through National Notary Assn. Commission �# EE 877971017
�.-i�;�- ._.._- ` OF Flo
Revised 07/15/2014 :, "' Are rAn T
_ _ ✓ hrough National Notary Assn.
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION_
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
Fort Pierce Utilities Authority
"Committed To Quality"
Key Accounts
206 S. 6th Street
Fort Pierce, FL 34984-3191
Phone (772)466-1600 Fax (772)467-3115
Job Location: 2110 N 45TH ST Invoice Number: KA-13344
Account Name: JOHN C CRANKFIELD
'PCN: 143180200030000
Contact Name: JOHN C CRANKFIELD LocID: 10006524-240590
Billing Address: PO BOX 3821 FORT PIERCE FL
34948
Phone: 17721242-1718 Fax:( ) - Cell: ( ) - Cust Type Residential , City Limits Outside
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1
.75
,Water Meter and/or Service Installation
$250.00
Water Security Deposit
$60.00
Water New Account Setup Charge
$40.00
Water Capital Improvement Charge
W ERC-s
0.00
$0.00
Wastewater Security Deposit
$0.00
Wastewater New Account Setup Charge
$0.00
Wastewater Capital Improvement Charge
WW ERC's
0.00
$0.00
Lien Fees
0.00
< V, + Wit"
L _ . .i A_. :t� .�'!'K
.. '
0.00
0.00
Down Payment: -s0.00
Invoice Total: $350.00
Description for service order: INSTALL 5/8" BY 3/4" WATER METER
HARMONY.HEIGHT MSBU
cam, ��
Total -To— A 7— t3 --Date-Pa - w
-- Check -Number: f'
Customers will be assessed wastewater charges the day they connect to the wastewater system or within 365 days from date wastewater Connection
Charge is paid - whichever is first. The cost of the service line from the point of delivery at the property line to the house/building Is the responsibility of the
customer and Is not included in this invoice. State laws require that a permit from the Health Department must be obtained prior to initiating a septic tank
abandonment. Contact the Health Department at (772)873.4931.
Construction cost estimates are based on current labor, equipment and material prices. Actual costs of construction will be determined at the completion of
the project Should unforeseen circumstances be encountered during construction, including but not limited to adverse weather conditions and
construction conflicts, the customer will be responsible for increased costs. Additional costs incurred by the customer shall not exceed fifteen (15)
percent of the total estimated construction costs shown above. Estimated costs paid by the customer that exceed the actual cost of construction will be
refunded by Fort Pierce Utilities Authority.
Reviewed By: Kurds Strand Key Account
&Specialist Date: 10/06/2014
Customer's Signature: Date:
Printed Name: Q G