HomeMy WebLinkAboutBuilding Permit Application i
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,�,,
Date: �r �� Permit Number: �f�f`�4 (Xyo
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RECENED
Building Permit'Application ''SAN 07 2020
Planning and Development Services permitting cepa 111"
Building and Code Regulation Division St,Lucie Co"
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
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PERMIT TYPE: REMOVE CONCRETE SLAB'
PROPOSECOMPROVEMENT:LOCATION:;_'
Address: 163 NETTLES BLVD LOT 163
Property Tax ID#: 4502-501-0349-000-9 Lot No. J
Site Plan Name: NETTLES ISLAND Block No. i
Project Name:
DETAILED D,ESCRIPTION'OF WORK:
REMOVE CONCRETE
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CONSTRUCTION INFORMATION;:
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Additional work to be performed under this permit–check all that apply:
Mechanical —Gas Tank —Gas Piping —Shutters _Windows/Doors
Electric —Plumbing —Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 46 Utilities: —Sewer —Septic Building Height:
"OWNER/LESSEE: J CONTRACTOR:
Name RONALD LINDA LECLERC Name:MACK MATOS
Address:163 NETTLES BLVD Company:MEL-RY
City: JENSEN BEACH State:_ Address:10967 S OCEAN DR
Zip Code: 34957 Fax: City: JENSEN BEACH State:FL;
Phone No.772-229-0012 Zip Code:,34957 Fax: 772-229-9440
E-Mail: Phone N0772-229-9439
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License23630
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL.CONSTRUCTION:LIENIAW IN'PORM ATIO,N
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip:- Phone Zip: Phone: i
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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. I
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 JOB SITE BEFORE THE FIRS SPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY B RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder II
STATE OF FLORIDA STATE OF-FLORIDA `
COUNTY OF_ Sk (,u�ne, COUNTY OF c t e.
The fprgoing instrumgnt was acknowledged before me The forgoing instrum nt was acknowledged before me
this�day of `�irv� 20?h by this & day of rave 20 2h by
Awe- Vlig G e,3 IM&A-k- M,(, r
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 Produced
dR Notary Public ch State of Florida � �p'►R� Notary Public State of Florida
Brian R Schafer Brian R Schafer
+�( My Commission G6 308842 r � Ery Commisaton GG 30SS42
Expires 03/05/2023
i ary Pu - (Signa ure of Wotar Public-
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Commission o. (Seal) Commission No. (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
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