HomeMy WebLinkAboutMartin, Shawn - 1054 Nettles Blvd, Water Line - Permit Application 8.21.17ALL APPLICA LE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 I1� 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
PROPOSED -��IMPROVEMENT LOCATION: `
Address: I D r}� i V� � l4 D r �E zlv
Legal Description: x,-41 Ds land qc A ondo ,ec, oo
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
no.►j0
,rJ
CONSTRUCTION INFORMATION:
Additional work to be jertormed un er this permit— check all that appy:
11HVAC Gas Tanis []Gas Piping_ Shutters Windows/Doors
Electric .Plumbing Sprinklers E Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ c5ru Utilities: 0Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 5,kawns fi 1. �" . . 01 1°i
Address: t lb Y\)r 4_+4 5 LIJ
Name: Y) A r ff
Company: e n IC 1, ivy G,
Address: 11� IV° - `T_,Ad M J Ai vl-,t3
City: Ijee) len &6,Ct - Stater
Zip Code: 3-' C1 5 � Fax: 9r,?5 —& 5
Phone No. 7,�Z — Ula 0-0
E -Mail:
City: lyej)5 n 15zC-,C L State: B,
Zip Code: 3161,51Fax:
Phone No. ..
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County ' ense: r 6 l - or' -
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Zip: Phone:
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
^ommenclnR worK or recor=9 vour N.etice of commencement.
of Owner/ Lesseontrac&r-as Agent for Owner (��nature of C or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF `ync tL4n COUNTY OF VY) o_Lkn
The forgoing instrument was acknowledged before me
this 21 day of 201-1 by
Name of person making statement
Personally Known.( OR Produced Identification
Type of Identification
Produced
( gn ture of - i a
JACLYN F WILSON
Commission N."° nny COMm1SSI(5IB yF1s9777
::�.��F�a�,•
EXPIRES November 8, 2418
td071398�0153 FloridaNataryservice.com
The forgoing instrument was acknowledged before me
this _i& day of ib1:4C'.{LN11 20 i by
IJ
Name of person making statement
Personally Known �� OR Produced Identification
Type of Identification
Produced
Com o -
, MY COMMISSION
SVovernber 8, ?-t
398-0153
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17