HomeMy WebLinkAboutBuilding Permit Application �1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y�
Date: Permit Number V . 000(o
97.Mats
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial x Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
O:POSED IMPROVEMENT LOCATI'O'N:
.PR
Address: 10545 South Ocean Drive
Property Tax ID#: 4511-500-0005-000-1 Lot No.
Site Plan Name: Block No.
Project Name: Surfside Grill
DETAILED DESCRIPTION CIF WORK:
Uk,5 112- n)'hAJ
� r
O n CST 4_5 CL1
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: {
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ i5_6 0 Utilities: —Sewer —septic Building Height:
OWN'ERAESS;EE: ',CONTRACTOR:
NameTammy L Simoneau Name: Pei,rk4ej n
PO Box 6146 I
Address: Company: I p
City: Jensen Beach FL State:_ Address: wd T�
Zip Code: 34957 Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail h
from the Owner listed above) State or ounty License Z
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW FN.FORMATIGN:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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.
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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 our Notice of Commencement.
Signature of 40RIDA,�
r essee/Contractor as Agent for Owner Signature o ractor/Li se Holder
STATE OF STATE OF FLORIDA
COUNTY OFCOUNTY OF
Sworn to(or affirmed)and subscribed before me of Swo to(or affirmed)and subscribed before me of
--Physical Preserice or Online Notarization Physical.Presence or Online Notarization
this U day of CF.e-- 2020 by this day of 2(�2_t�Yl / ,2020 by
11 /LA_ u—, �' A+�y ►'�S Ili
Name of person making itatement. Name of person making statement.
Personally Known `/ OR Produced Identification Personally Knowrilki OR Produced Identification
Type of Identification Type of Identification
Produced A '1% Produced
b_4 C�
(Signature of Notary Public-State of Florida) nature of Notary Public-State of Florida)
Commission No ! b o.*°'°`gr�Se �ary publie State of Flori a �,A
x a!Galvin Co mission No x"? DO CHUPELA
• my Commission GG 1986 = %Notary Public-State 9 9835it
Expires OW2112022 :• Commission it GG 948835
y commission txplr03
REVIEWS FRONT ONING SUPERVISOR PLANS VEGETATI ua y
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20