HomeMy WebLinkAboutPermit App_ExecutedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3/26/2021 Permit Number:
S)TO LSl .1CM Qn�6
O
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Renovation 1
PROPOSED IMPROVEMENT LOCATION:
Address: 12387 S Indian River Dr., Jensen Beach, FL 34957
Property Tax ID it: 4504-603-0014-000-1
Site Plan Name: PT Lot 3 Miller's S/D
Project Name: Eric Kobrin
DETAILED DESCRIPTION OF WORK:
Remove paneling from walls and replace with drywall, finish drywall
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot N o.
Block No.
Additional work to be
MU
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: $
15,000.00
Utilities:
-Sewer _ Septic Building Height:
FSSFF�
CONTRACTOR:
.N.ER/I
Name Eric and Brenda Kobrin
Name: RobertAmbrosius
Address: 12387 S Indian River Dr.
Company: One Call Florida, Inc.
City: Jensen Beach State: _
Zip Code: 34957 Fax:
Phone No. L
Address: 7804 SW Ellipse Way
City: Stuart State: FL
Zip Code: 34997 Fax:
Phone No 772-223-8400
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail lori@onecallflorida.com
State or County License CGC1519002
If value of construction is 2500 or more, a RECORDED Notice oT Commencement I5 regwrea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name:
Name:
Address:
Address: _
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: x 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 attorneybefore commencingwork orrecord our Notice of Commencement.
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Signature of Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Mania
COUNTY OF Mame
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
__.IL Physical Presence or _ Online Notarization
this day of tnoeo?ih. 1200 by
I
bLL _ Physical Presence or Online Notarization
this '_ clay of 1A9W A , 202,9 by
Robert Ambrosius
Robert Ambmsius
Name of person making statement.
Name of person making statement.
Personally Know OR Produced Identification
Personally Known DL OR Produced Identification
Type of Identi ion
Produced
Type of Identificati
Produced
(Si atu a of N�
(Signatu o F i
yra' Notary Public State of Fbride
Commission No. +'R t, Lod Jean R"@al
ya Eiwiroe 04urJw1 Z� 323795
Or Notary Public SUIa Of
Commission dP t. Lod J Rose e
j = Cammiseion GG 379796
a wa' ExPiros 04115/2023
REVIEWS
FRONT
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
ZONING
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 20