HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 51aS1i'� Permit Number:
ITEM.., wil_,. RECEIVED IyAY 2 5 2017
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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 10725 S OCEAN DRIVE#359
Legal Description: HOLIDAY OUT AT ST LUCIE-SEC B BLK R LOT 10 AND EQUAL PRO-RATA INTEREST IN COMMON
ELEMENTS (OR 1193-2569).
Property Tax ID#: 4511-502-0163-000-2 Lot No. 10
Site Plan Name: Block No. R
Project Name: HATALA
Setbacks Front. Back: Right Side: Left Side:
DETAILED DESCRIPThON OF WORK': ' ,'-
EXACT
ORK:EXACT A/C CHANGE OUT 3 TV
Kms/
CONSTRUCTION INFORMATION:
Additional workto a er orme under this permit—check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
E]Electric 0 Plumbing Sprinklers Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ 5950.00 UtilitiesSewer Septic Building Height:
OWNERAESSEE: : x - CONTRACTOR:
Name RICHARD HATALA Name: MARK A VINES
Address: 10725 S OCEAN DRIVE Company: AZTIL
City: JENSEN BEACH State:_ Address: 2540 S MILITARY TRAIL
Zip Code: 34957 Fax: City: WEST PALM.BEACH State:FL
Phone No. 772-229-8902 Zip Code: 34957 Fax:
E-Mail: Phone No. 561-433-2197
Fill in fee simple Title Holder on next page(if different E-Mail: PERMITS@AZTILAC.COM
from the Owner listed above) State or County License: CAC049253
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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:
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 th st inspection. If you intend to obtain financing, cons It with lender or an attorney before
comme,Kcpg work or recording yopr Notice of Commenceme
of s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Licens der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST.LUCIE COUNTY COUNTY OF ST.LUCIE COUNTY
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 311,7_day of IYVAV 20 (I—by this 209' day of 1�� 20 1-7)—by
MARK A VINES 1 MARK A VINES
(Name of person cknow ed' }9;, JOHN EDWARD GIFFO (Na of person ackno a �'�e�-JOHN EDWARD GIFFORD
NAY COMMISSION#FF0774 7
MV COMMISSION#FF077427
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(Sig ature of No ary P b - a e o Florida (Si` ature of ota u -
Pers ally Known x OR Produced Identification Per nally Known x OR Produced Identification
Type o Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS