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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �Q ^^n
Date: Permit Number:J is -
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: Demolition El
PROPOSED IMPROVEMENT LOCATION:
Address: 1072 S.Ocean Drive,Jensen Beach FL 34957
Legal Description: Holiday Out at St.Lucie Bik K Lot 1,equals PRO_RATA interest in common elements(or 3802-2347)
Property Tax ID#: 4511-501-0298-000-4 Lot No.103
Site Plan Name: Holiday Out Block No. K
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF WORK: .
Removing old trailer
'.CONSTRUCTION INFORMATION:
itiona work toe e orme under this permit—check a appy:
HVAC Li Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric 0 L�...I Plumbing Sprinklers E]Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft,of First Floor:
Cost of Construction:$ /iy— Utilities:0 Sewer EISeptic Building Height:
OWNER/LESSEE: '.,CONTRACTOR:
Name Jerry&Kay Thiel Name: Mack Matos
Address:10725 S.Ocean Drive Lot#103 Company: Mel-Ry Construction, Inc
'City: Jensen Beach State:FL Address: 10967 S.Ocean Drive
Zip Code: 34957 Fax:N/A City: Jensen Beach State:FL
Phone No.772-229-9439 Zip Code: 34957 Fax: N/A
E-Mail:Mack@mel-ry.com or teresa@mel-ry.com Phone No. 772-229-9439
Fill in fee simple Title Holder on next page(if different E-Mail: mack@mel-ry.com or teresa@mel-ry.com
from the Owner fisted above) State or County License: 23630
'If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION°LIENLAW INFORMATION
F ..
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.
11 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
IIn 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
commencing work or recording o r Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ` JqA STATE OF FLORIDA
COUNTY OF COUNTY OF t C
The f rgoing instru 1 ent was acknowledged before me The fo oing instr ment was acknowledged before me
this V- day of -L 20 V by this day of L'CL 20A by
Name of person making statement Name of p rson making statement
Personally Known_ OR Produced Identification Personally Known V OR Produced Identification
Type entification Type of Identification
Pro uced Produc AI
( gna re of a 'li 5' f ION#FF227168 ( gn re of o P ii:?� 'flf FI
;�. MY COMMISSION#FF227168
�XPI �R ay 05.2019 '.�+o:...•`, EX Me 05.2019
ommission No. FtwNtll� Commission No. $) Y
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REVIEWS FRONTir ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17