HomeMy WebLinkAboutBuilding Permit Applicaiton ALL INFO � 41r T COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
YU /) Permit NL- �E ei. 1)
umRECEIVED
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Building Permit Applicatior
OCT 1.8 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
- 2300 Virginia Avenue,Fort Pierce FL 34982 C I e�0 County,t FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial ies n yr
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
EF ROPQSED_I PROVEME1NT3OCATIO[ ; '
Address: 12035 S Indian River Dr,Jensen Beach
Legal Description: TOP OF WALTON S/D TONS OF 30 AND 31 WITH RIP RTS(OR 37942153)
•
Property Tax ID#: 4504-601-0030-000-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
C E "AI IriG ) ESC I TIO F OR Irii'H 3 4• 1#
j a-J 5-10-Lite r'is* ce4441,deed( `tom.-`16- ' i lei- SI i Z ¶r-1-Ck
h hl cam- gv e 1Q
631.
CO " UC 'IQ Ii ORMA` O E �
Additional work to be erformed under this permit—check all apply: •
HVAC Gas Gas Tank nGas Piping I Shutters n Windows/Doors
Electric ❑Plumbing Sprinklers El Generator R1 Roof 5/lt, Roof pitch
Total Sq.Ft of Construction: Z ID 0 0 S .Ft.of First Floor:
Cost of Construction:$ / b, OO Utilities:I'Sewer El Septic Building Height:
.;OU, NERILESSEE . _ CC(SIJ?ACTOR .......
NamèEfbon investments LLC Name: Jeffrey Albert
Address:4516 Danson Way Company: Jeff Albert Roofing,Inc
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City: Delray Beach - State:FI Address: 4561 W Atlantic Ave#101
Zip Code: 33445 Fax: City: Delray Beach State:FI
Phone No. Zip Code: 33445 Fax: 561-278-9730
E-Mail: Phone No. 561-988-6001 •
Fill in fee simple Title Holder on next page(if different E-Mail:Jeff@jeffalbertroofing.com
from the Owner listed above) State or County License: CCC1327187
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S IPPLElMIENTALq CONSTRucii4�O� N LIEN
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:1me:Elton investments LLC Name:Jeffrey Albert
Address:12035 S Indian River Dr,Jensen Beach Address: 4516 Danson Way
City: Delray Beach State: . City: Delray Beach State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:4561 WAtlantic Ave#101 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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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
commencing work orre ording your Notice of Commencement.
Signature of Owner/Lessee/Contractor-as Agent for Owner Sig d • e of Contractor/License Holder
STATE OF FLORIDA TATE OF FLORID
COUNTY OF j P14 Clrl COUNTY OF Yoi.I Irl
�' rh 13e�
The for pin instrument was acknowled ed efore me
The for oln instrument was acknowled ec,,before me g g g
this IX day of DGI,o} r- ,20 td" by this t�O day of OC�12e-tf ,20 Lade by
3o&c \ E Pr-o A-V -)-
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known 1...."---C—)R Produced Identification
Type of Identification Type of Identification
Produced Ul G-12-mA Produced
(Signa u -of Notary Pu.li . •- '_natu a of Notary Public- tate of Flor'e; )
NO
• <o'T Pitt Notary Public State of Florida j tic State of Florida
Commission No. i, ,. T° , S( li)Oie Rodriguez CI mission No.I ) Co``' -,•' 1,408t�dt8i� Rodriguez
'•A My Commission GG 108602 •
my Commission GG 108602
eoF tos` Expires 05/25/2021 •
d` Expire12021
Expires
oFr�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17