HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: 12/02/2019 Permit Number:
RECEIVED
Building Permit Application 'JAN o7 2020
Planning and Development Services
Building and Code Regulation Division Permitting
. Luce Counmenc
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMITTYPE:guilding
PROPOSED IMPROVEMENT LOCATION:
Address: 163 Nettles Boulevard Jensen Beach, FL 34957
Property Tax ID #: 4502-501-0349-000-9
Site Plan Name:
Project Name:
I DETAILED DESCRIPTION OF WORK:
r
CONSTRUCTION INFORMATION:
Lot No.163
Block No.
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: �9 n I �1 Sq. Ft. of First Floor:
T
Cost of Construction:$ Gf Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Ronald LeClerc, Linda Emard, Patrick Leclerc
Name: Mack Matos
Address:163 Nettles Boulevard
Company: Mel-Ry Construction
City: Jensen Beach State: _
Zip Code: 34957 Fax:
Phone No.
Address:10967 S. Ocean Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax: 772-229-9440
Phone N0772-229-9439
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Mack@mel-ry.com
State or County Licen.c 3-'�p 010
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.
� / I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/EN �INEE : Not Applicable
Name: 3 /ti -( `J C11A `�
Address: / sr ceCo (v) fp
City: S J H n State: 7-V
Zip: 349 6 Phone 77-� • - -b-� t=tr
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.!
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF�*- Luc«
COUNTY OF % (.O of
The forgoing instrument was acknowledged before me
The forgoing instrum nt was
acknowledged before me
this (, day of '54.vi 20Z,o by
this 3L day of r,
20 20 by
"AaA(L QfA6 S
Vvac(G u1l &It
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known V OR
Produced Identification
Type of Identification
Type of Identification
Produced riu of Fbdda
roduced
Ban R Schafer
t My Commission GG 308542
Expires 03/06/2023
NMM 7 PaMta Same of FWda
JJ Brian R Srhdar
p
Zell
(Signs ure ry Publ
cam, Mr Commission 00 308842
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(Signature o ry Public -State of Florida)
Commission No. (Seal)
Commission No.
(Seal)
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