HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9/14/16 Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 I X
Phone: 772 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 10104 CROSBY PLACE
. POD 26 AT THE RESERVE PHASE II CYPRESS POINT LOT 63 (OR1272-178: 1273-2308)
Legal Description.
Property Tax ID #: Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
r/C
T-7
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Block No.
CONSTRUCTION INFORMATION:
A itiona wor to e er orme under this permit — check a appy:
7HVAC Gas Tank Gas Piping In _Shutters a Windows/Doors
❑Electric � PlumbingSprinklers � Generator � Roof Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: $ 7,000.00 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ROBBERT MADDEN Name: ALBERT KUEBLER
Address.
. 10104 CROSBY PLACE Company: KUEBLER MECHANICAL INC.
City: PORT ST. LUCIE State: FL Address: 535 NW MERCANTILE PLACE, #101
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34986 City: PORT ST. LUCIE State: FL
Zip Code: Fax. '
Phone No. 772-464-0764 Zip Code: 34986 Fax:
E -Mail: Phone No. 772-878-2281
Fill in fee simple Title Holder on next page ( if different E -Mail: reelkool@msn.com
from the owner listed above) State or County License: CAC058105
If value of construction is $2500 or more, a KtLUKUtU imoxice or t.omrnenLCrr1Cr1L 1� I cyu11 cu.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Add cess:
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 vour Notice of Commencement.
Sign��ure of Owner/Lessee/Contractor as Agent for Owner I Sig ture of Contr,-dctor/License Holder
STATE OF FLORIDA
COUNTY OF STLUCIE
The forgoing instr ent. was acknowledged before me
this 'aay of ,fin r , 20 16 by
ALBERT KUEBLE'R
(Name of person acknowledging )
4' *N%.
Signature of Notar Pu - State of Florida )
Personally Known x OR Produced Identification
Type of Identification Produc N
Co41 Z rommission
mission # FF 9256
Commission No. FF 925685 z4 *s (S EX�)IrE
-�r�r� OF F 1.�Q�,'�
'•���►���,�,. October 08, 2019
Revised 07/15/2014
STATE OF FLORIDA
COUNTY O F ST LUCIE
The forgoing instrument was acknowledged before me
this 14TH day of SEPTEMBER 20 �I by
ALBERT KUEBLER
(Name of person acknowledging )
I gnagAre of Notary ub - State of Florida )
Personally Known x OR Produced Identification
of Identification Produced -
R
EORGIA L. HEFTN
mission #FF 9756
sC0 mission No. FF 925685 =� . s Commission Expir(
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,' :�:.a►�4p;:�'~� October 04► 2019
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