HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLENFOpM�YST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: � \` Permit Number: ro
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 X Residential
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION:
Address: Mile Lake Village Condominium Assn., 12600 Harbour Ridge Blvd., Palm City, FL 34990
Legal Description: Mile Lake Village Condominium, Building 4, Units 1 -8, 13250- 13264
Property Tax ID#: 4426-801-0001-000-6 Harbour Ridge Blvd., Palm City, FL 34990 Lot No.
.Site Plan Name: Block No.
Project Name: Mile Lake COA
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTIONOF WORK:
Replace all windows in each of the 8 units
CONSTRUCTION INFORMATION:
Additional work to be nerformed un er t is permit—check a appy:
HVAC Gas Tank E]Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:; Utilities: _Sewer[]Septic Building Height:
lop
OWNERAESSE;E: CONTRACTOR:
Name Mile Lake COA Name: Steve Rubin
Address:12600.Harbour Ridge Blvd. Company: Rubin Custom Homes
City: Palm'City' - a State:FL Address: 4253 High Meadows Ave.
Zip Code: 34990 Fax:772-336-1469 City: Palm City State:FL
Phone No.772-336-3000 Zip Code: 34990 Fax:
E-Mail:p-epperson@hrycc.org Phone No. 561-222-1392
Lj--"j1[ Fill in fee simple Title Holder on next page(if different E-Mail: reception1.rubincustomhomes@gmail.com
the Owner listed above) State or County License: CGC1518190
nstruction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x 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 our Notice of Commencement.
A s
_Signatur of wner/Lessee/Agent re of Contractor/License Hol er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St.Luee COUNTY OF St.Lucie
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledg before me
this day of t�� 20 4 by this day of 20 by
(Name of person acknowledging) (Name of erson acknowledging)
(Signature of Nota Public-State of Florida) (Signature of Notary Publsc tate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
SHERRI LEY
Commission No.1Eb'g(.c't .+: SHIRLEY A. ACgrMnissi No. ;� SXe
- OMMISSiON�!EE225005
i+2°� 4`�= Notary Public-St to of Florida t '.
-°a My Comm. Expires Jan, EXPIRES October 04,2016
�,"+? Commission EE 861169 taorl3®ao+s3 '10naarJOwryServiee.mm
OF FU
+
Revised 07/15/2014
"` Bonded Through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS