HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t,
Date: a^Co 1� PermitNumber:l�()Mal
a
RECEIVED
Building Permit Application „ _
Planning and Development Services F E B 2 6 �-J 1
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982 ST. Lucie County, Permitting
Phone: (772)462-1553 Fax: (772.)462-1578 Cornmercial Residential X
PERMIT APPLICATION FOR: Demolition
PROPOSED IMPROVEMENT LOCATION:
Address: 1044 Nettles Blvd
Legal Description: 1044 Nettles Blvd, Jersen Beach, FL 34957;lot#1044 -- —
Property Tax ID#: 4502-501-1231-00-6 -- – -- Lot No.1044
Site Plan Name: Nettles Island Block No.
Project Name: _
Setbacks Front Back: Right Side:_ Left Side: _
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Add itio”na w__orktobe erformed- unci-er tTiis permit—cFieck a-1 apply:
HVAC Gas Tank OGas Piping _Shutters Windows/Doors
❑Electric ❑ Plumbing Sprinklers ❑1_Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: c/ SFt,of First Floor:
Cost of Construction: $ i 75�Q� Utilities: Sewer F]Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name uAv1C.V)L0 1 Q Name: )V
Address: Company: �' C
City: State: Address: 1 U__l OCeGYI
Zip Code: Fax: City:7e_)4S &QLVI, State:
Phone No. ��Z 2-2-1 l _ Zip Code: 5ftYl Fax:
E-Mail: Phone No. Z- ZTcl.
Fill in fee simple Title Holder on next page( if different E-Mail: `' CDYVk� r,r lecf5ct Mt
from the Owner listed above) State or County License: 2–
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: 1 1�
Address:1044 Nettles Blvd Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: fA Name: N 1�
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 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 intepo to obtain financing, consult with lender or an attorney before
commencing work or recording ou N tice of Commencement.
Signatur of Owner/Les a/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF `:_LLL t C COUNTY OF Isk u_kc "L
The forgoing instrpment was acknowledged before me The forgoing instr ment was acknowledged before me
this �L dayof i'U 201 by -- this \L day of�1t.C,% 20_1,�) by
ct
\� Name of pe rs n making statementie Ir—
h ; l Name of person making statement h
Personally Known OR Produced Identificatfon Personally Known CV OR Produced Identification U
Type of Identification —1 Type of Identification {
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(S' nature tary Public-/State of Florida) o T 3 (Si ature of Notary ublic- tate of Florida) 0
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Commission NoAV,_2----1\Lr r� (Seal) § m � M Commission No. �ZZ Lo'6 (Seal) o N
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17