HomeMy WebLinkAboutSPECIALTY PERMIT APPLICATIONe• fee Due: � � [)teceipt# �,' `_rmit #
Planning & Development Services
c`? Building & Code Regulations DivisionC,9
2300 Virginia Ave. St e��/�•
Fort Pierce, FL 34982
(772)462-1553 CO
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SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing 0 HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: 11.000 S . 0 Cea n r. 4-F- E;
2. Parcel ID Number: tlS 1a - '101- 00-70 - 0O0 -i
Office Use
Only
Section
Township
Range
Map Page
Zoning
La Use
Initial
3. Complete Description of Project or Work:
4. Owners Information 5. Contractors Information
Name: 1,enni5a-kle�tan&ra I Llakaq FLReg/Cert#:
Address: (� Q }� b �, p A-V e . County Cert#:
City: � j f1J State: Business Name:
25113
METOT611.00MI1104MI.
Zip: 19920 Phone: ,30a - 537- & I ( ) Phone: 772-336-9030 Fax: 772-336-9032
� ao
6. Value of Construction: $ �,)i 10—
OWNER'S AFFIDAVIT: I certify that all of the information contained it
compliance with all applicable laws regulating
Jacques C. Stiegelman
PRINT OWNER OR CONTRACTOR NAME
is correct and that all work will be done in
zoning.
OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF St. Lucie
ACKNOWLEDGED BEFORE ME THIS 154-bDAY OF 20 A BY Jacques C. Stiegelman
WHO IS PE ONALLY KN WN T ME X OR WHO HAS PRODUCED N/A _
AS I IFMATION. Z Ay KRISTINA R. PARSONS
NOTARY PUBLIC
alw a Kristina R. Parsons STATE IRF5LORIDA
SIG ATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY COMM# FF007936
COMMISSION NUMBER FF007935 ` NcE 1P'N Expires 412312017
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
EVIPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
Name: _
Address:
City:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
x Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
x Not Applicable
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
comnirenciriR wo* oh recording vour Notice of Commencement. A A A
of Owner%Agent/ Lessee
SWE OF FLORIDA
COUNTY OF St. Lucie
The forg ing instru nt was acknowledged before me
this lay of 20 by
C.
(Name of/person
re of Notary Public- State of Florida )
Signature ofiDentractor/ricense Holder
STATF/,OF FLORIDA
COUNTY OF St. Lucie
The forg ng instrunAnt was acknowledged efore me
this - 5Nay of 20W by
(Name 0 person ackn
of Notary Public- State of Florida )
Personally Known XX OR Produced Ide ti ' N/A Personally Known XX OR Produced Identification N/A
Type of Identification Pr KRISTINA �. �1� Type of Identification Produced
01 AK a ORIDA ISTINA R. PARSONS
Commission No. FF STATE E Commission No. FF00793dtb.
Nq%gRPUBLIC
Commt FF 7935 STATE OF FLORIDA
Exolr®s 4/23/2017Cammfi carmv......
Revised 07/15/2014
4/23/2017
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED