HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: rP 1 Permit Number:
• RECEIVED
Building Permit Applicatio
Planning and Development Services MAY 2019
Building and Code Regulation Division ST. LU
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2300 Virginia Avenue,Fort Pierce FL 34982 9
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical
'Pig RR(OVEIMAE;Til{OCATLO'N;
Address: 10701 S OCEAN DRIVE UNIT 663 JENSEN BEACH, 34957
Legal Description:
Property Tax ID#: yclCdr. G06LotNo.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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TON 2.5
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Additional work toe nerFormed under this permit—check all appy:
HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 880 Sq. Ft.of First Floor:
Cost of Construction:$ 5675.00 Utilities:Sewer Septic Building Height:
0WNdER/LESS[EIE;: CONGT®lR
Name JERRY FOSTER Name: MARK A VINES
Address: 10701 S OCEAN DRIVE#663 Company: AZTIL
City: JENSEN BEACH State: FL Address: 2540 S MILITARY TRAIL
Zip Code: 34957 Fax: City: WEST PALM BEACH State:FL
Phone No.740-506-0965 Zip Code: 33415 Fax:
E-Mail: Phone No. 561-433-2197
Fill in fee simple Title Holder on next page(if different E-Mail: PERMITS@AZTILAC.COM
from the Owner listed above) State or County License. CAC049253
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
��"S�U�P�P LE MfE;N�Tt�A�L tC®,,`,STR�UICTI O N.ryL'I E N�LAW�a°f NIF'O;R�M►A�TIi®;N1:; µ"4y=� . '.�`�_�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: JERRYFOSTER Name:MARKAVINES
Address:10701 S OCEAN DRIVE UNIT 663 JENSEN BEACH,34957 Address: 10701 S OCEAN DRIVE#663
City: JENSEN BEACH State: City: WEST PALM BEACH State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:2540 S MILITARY TRAIL 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 intend to obtain financing, consult with lender or an attorney before
commencingymyrk or recordiag your Notice of Commencement.
Signature of Owner Lessee ontractor as Agent for Owner Signa ure of Contra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALMBEACH COUNTY OF PALM BEACH
The forgoing instrument was acknowledgef before me The forgoing instrument was acknowledged before me
this 16 day of MAY 20'1 by this 16 day of MAY 20a by
MARK A VINES MARK A VINES
Nameo erson making statement Name o�son making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ide ti ication Type of Iden ' ' ation
Produced Produc
(SignFof l - i a natu of Notarov?uo� Notary Public State of Florida pr aNotary Public State of Florida
Co a John Edw�rd� fford Commission N s� ^ John Ed%ft 'lord
My Comms i G 147815 ,!,- Q My Commi sion""U�'G 147815
of n°� Expires 12/1712021 9ipoF Expires 12117/2021
REVIEWS FRONT ZONING SUPERVIS PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17