HomeMy WebLinkAboutSUBMITTED PAPERSAll APPLICABLE INFO MUST BE COW, `;ED FOR APPLICATION TO BE ACCEPTED
Date: -d- SCANNED Permit Number:
BY
St. Lucie County
R� "M
�A I-OLTIR
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
PERMIT APPLICATION FOR:
Address: Y 3 () 1:2-
Legal Description:
Property Tax I D #:
Site Plan Name:
Project Name: _
Setbacks Front
wo rK to ne pe
M
Back: Right Side: Left Side:
pe rm it - cneCK a i i tnat a
Lot NO.
Block No.
Mechanical GasTank Gas Piping Shutters---- Windows/Do.ors
Electric X Plumbing Sprinklers Generator R
Pof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 104) Utilities: —Sewer _Septic Building Height:
.Name' J�
Address-9 9(2,Q-. Q,iron( . I A,, I/ --c
City: State:
Zip Code:3 q 6/ 5 Fax:
Phone No. r7 Q �2 - Z,3a -Of-0,
E-Mail: -e �r �) 5� t 0L); 0 0,o� '
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company:
Address:
City:
Zip Code:
Phone No.
E-Mail:
State or County License:
Fax:
State:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGN ER/ENGI N E ER:
Name:
Address:.
City:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: - Phone: -
Not Applicable MORTGAGE COMPANY: Not Applicable
I Name:
State:
— Not Applicable
Address:
City: State:
Zi p: Phone:
BONDING COMPANY: . Not Applicable
Name:
Address:
City:_
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 ermit holderto build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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.
Signatdre of 0-w—ner/Agent/ Lessee
SignSture of Confractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF -1c.,
Si Lk
COUNTY OF -'XIJJ�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this,4 day of Maoi�!,\ 2o L6 by
this ?_ day of :r( 20 IS— by
(Name of pei
�wlekflt+ HATHCOCK
(Name of person acknowledging
MY COMMISSION #FF077402
IRES De m ber 17,2017
-W_ MM
(J a" �__
_Q. -
(Signatur0i o 3tare-OT Floricia
\-(S-Kgnafure of Notary Publk- State of Florida
Personally Known Produced Identification
Personally Known OR.Produced]den ic inn
__4!f:----OR
Type of Identification Produced
Type of Identification Prodb lg�llfinOlgj POPOR ............
60w� 4:1 # U01s'"11100
mwldgDNIIVNHV�1�
Commission No. (Seal)
Commission No. '0Z 380 SOKOW00
eppOIA 16 3121IS - 311qnd ARION
V
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW ,
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVLD
DATE
COMPLETED
Rev. 7/2014
Fort Pierce Utilities Au-7--lirity
"Committed To Quality"
Key Accounts
206 S. 6th Street
Fort Pierce, FL 34984-3191
Job Location: 9302 ORANGE AVE
Account Name: MICHAEL P BELL
Phone (772)466-1600 Fax (772)467-3115
InvoiceNumber: KA.111-14
PCN. 231014200020009
Contact Name: MICHAEL P BELL LocID: 10006490-240028
Billing Address: 9302 ORANGE AVE FORT PIERCE FL 34945
Phone: (772)332-4385. Fax: Cell:( CustType Residential Citv Limits Outside
N;X- �,zv,,
04
5/8 X 3/4"
Water Meter and/or Service Installation
$800.00
Water Security Deposit
$60.00
Water New Account Setup Charge
$40.00
Water Capital Improvement Charge
W ERC's
$920.50
Wastewater Security Deposit
$0.00
Wastewater New Account Setup Charge
$0.00
Wastewater Capital Improvement Charge
VWV ERC's
0.00
$0.00
Lien Fees
. . . . . . . . . . .
137.50
0.00
0.00
Pown Payment: $391-60
Invoice Total: $1,566.40
Description for service order: INSTALL 5/8 X 3/41, WATER METER W/ SERVICE
Total Paid: Date Paid: Li Check Number:
Customers will be assessed was tewater 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 ofthe
c ustomer 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: Lori Battipaglia Key Accounts Specialist Date: 08/13/2014
Customer's Signature: r%
Printed Name: