HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: ` • ,\ • �� Permit Number:
'J -
Building Permit Applicationr7RECEIVED
3 O 2018Planning and Development Services
Building and Code Regulation Division ucie County, Permitting
2300 Virginia Avenue, Fort Pierce Ft 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: 118 Ocean Bay Drive Jensen Beach, FL 34957 elpA
Legal Description: Ocean Bay Villas unit 18
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace electric water heater 50 gals 2nd floor
CONSTRUCTION INFORMATION:
Additional work to a ereoorm�ncTer t is permit—c ec c a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator Ll Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft,of First Floor:
Cost of Construction:$ 1050.00 Utilities: 11 Sewer F]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Brian Belknap Name: Jay Palmer
Address:118 Ocean bay Drive Company: Quality Drain Solutions
City: Jensen Beach State:FL Address: PO Box 1466
Zip Code: 34957 Fax- City: Port Salerno State:FL
Phone No.954-296-4231 Zip Code: 34992 Fax:
E-Mail: Phone No. 772-220-7577
Fill in fee simple Title Holder on next page(if different E-Mail: qualitydrainsolutions@yahoo.com
from the Owner listed above) State or County License: CFC 1427885
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN 4AW INFOWATION:
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:
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 thepermit 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
cornmencing work or recording our Notice of Commencement. r/}
Signature o O r/Lessee/Contractor as Agent for Owner FSignafure o Contractor/License Holder
STATE OF FLORIDA -' -1 TE OF FLORIDA.
COUNTY OF / r
,/ ` �r: ^ ~ COUNTY OF (.0 / ,- c (A,..
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of / 20_ by this day of 20_ by
yu
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
.Produced ,"ticed
(Signature of ,µ rc State �9iTkl&I} o 01 Florida (Sign Tart
i!
Notary Public Stale of FraY Pel, ,
Commission N = mmissia66�afF 191045 Com Notary Public State of Florida
• ' 2019 _ o FF 191
=s, oc My Comm.Expires Mar 31,
BortdeOttxou9hNalogNotaryAsst• ?s�e c My comm.Expires Mar 31,2019
i pF F�
oral Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLAN % VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17