HomeMy WebLinkAboutDillingham Permit Application 12.8ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: _
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: To Select from dropbox, click arrow at the end of line
Address: 2.2t£> :43vd $t: Pt '\?(:,y CL 1 b '-?J:l:C}-h ()
Legal Description: \:-ttvmro \j \s\ucpts � 4 fil. :1 \_,otS \h LAhd }4
Property Tax ID#:------,,----------------------
Site Plan Name: \l extn I CR D'i \ \ l V'q\r)('.;t yY) �, --;--o
Lot No. _
Block No. ---
Back: Right Side: Left Side: _
Project Name:------------------------------------
Setbacks Front _
DETAILfD
\Y'\S-\R01 \�· %lo' �rc.e.
O Windows/Doors
ORoof
er t rs permit - c ec a app y:
OGas Piping Shutters D Sprinklers D Generator
mona wor to
DHVAC
DElectric
i
CONSTRUCTION.INEORMATION: . . \''·, � .
State:£.l:___
Building Height: _
CONTRACTOR:
Phone No. 321-636-2829
E-M a i I: spacecoast@superiorfenceandrail.com
State or County License: _2_
9
5_8_9 _
S'f£!; of First Floor:
Utilities: LJ Sewer D Septic
Name: Todd Paroline
Company: Superior Fence and Rail
_...._.--+- .......... ��--------State: a- Address: 2778 N Harbor City Blvd #102
City: Melbourne
Zip Code: _3_
2
9_3_5 Fax: 321-638-0086
from the Owner listed above)
Phone No. ----------------
E - Mai I: _
Fill in fee simple Title Holder on next page ( if different
Total Sq. Ft of Construction: _
Cost of Construction:$ 2.0\e:lp
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
_ Not Applicable DESIGNER/ENGINEER:
Name: -------------------- Address: ------------------- City: State:
Zip: Phone: _
MORTGAGE COMPANY:
Name: �
Address: _
City: State:
Zip: Phone: _
_ Not Applicable _ Not Applicable FEE SIMPLE TITLE HOLDER:
Name: Addres-
s
:-------------------
City: ------------------- Zip: Phone: _
BONDING COMPANY:
Name: _
Address: _
City: _
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
comme in work or record in our Notice of Commencement.
�#� s ��-------------------- Signature of Contractor/License Holder
STATE OF FLO�
COUNTY OF �LUW J
The forgoing instr� was acknowledged before me
this L day of fil\g.k , 20 UQ.by
The forgoing instru�=�wledged before me
this g day of \\_ ffi V.20 lli__ by
:JO dci, Y\ '.P0vvoturu.-!
(Name of person acknowledging)
, r Q MJ\ CCA: �, \ \ l�(UYJ
(Nai'l-ie of person acknowledging
Personally Known OR Produced Identification ..«.
Type of Identification Produced _ __...f'-�
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Personally Known 'f:
Type of I dentifi catio�e��!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!e!!!!!!!�:t---
Commission No. STEPHANIE BROOKS 1
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MYCOMMISS�ij21712' I EXPIRES: April 5, 2019 J Bonded Thru Notai:y Public Unde"":iim__
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS
NOTICE OF COMMENCEi
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT
SAINT LUCIE COUNTY
FILE# 4252106 11/28/2016 04:36:06 PM
OR BOOK 3936 PAGE 1062 - 1062 Doc Type: NC
RECORDING: $10.00
ST A TE OF Florida
COUNTY OF llh&rJl,iFEt ,Sf l..tlCLeL
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes
the following information is provided in this Notice of Commencement. '
I.
2.
3. Owner information:
a. Name and address:
b. Phone number:
c. Name and address offee simple titleholder (if other than owner):
4. Contractor:
a. Name and address: Superior Fence and Rail of Brevard County, Inc. 2778 N Harbor City Blvd, Ste 102, Melbourne, FL 32935
b. Phone number: 321-636-2829 ---------------------
5. Surety:
a. Name and address: n/a ---'-"-=----------------------------------
b. Amount of bond$-"-�-------------
6. Lender:
a. Name and address:
b. Phone number: �n�
/
a�------------------
7. Persons with the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1 )(a)7.
Florida Statutes:
a. Name and address: _n_/�a _
b. Phone number: �"�'�-------------------
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13( I )(b),
Florida Statutes:
a. Name and address: �"�'�a�----------------------------------------
b. Phone number: �"�'�a�------------------
9. Expiration date of notice of commencement (the expiration date is one (I) year from the date of recording unless a different date is specified) _
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE COMMENCING WORK O ..cCORDTNG YOUR NOTICE OF COMMENCEMENT.
I
Signatory's Title/Office -t0-0,..
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c. Phone number: �"�
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- «, STEPHANIEBRCO\cl !i> .·\t\ MY COMMISSION# Fr 211123 it
.. �.:.if EXPIRES: April 5, 2019 1�
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n tur of Notary Public - State of Florida
Print, type, or stamp commissioned name of Notary Public
Personally Known OR Produced ld;;!JJification "{:
Type of identification produced '{1 /)L f::, Y"'J?--'"i"t:{J- '57- )/ �-()
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