HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 2
Date: Permit Number: 1$ 03 -01 r' I I
Building Permit Application
Planning and Development Services MAR 2,6 2M
Building and Code Regulation Division Per"tting De
paitmeat
2300 Virginia Avenue, Fort Pierce FL 34982 SL Lucie coup
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line II
PROPOSED IMPROVEMENT LOCATION:
Address: 9815 S Ocean Drive, Jensen Beach FL 34957
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove (8) Dockside Power Pedestals, so dock wood could be repaired. Then, re -install Pedestals.
Repair knock -out on Power Lift boxes on B Dock east
Lot No.
Block No.
CONSTRUCTION INFORMATION: III
OHVAC U Gas Tank
Electric El Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 900.00
JCI I IIIL—LIICLKdill dpply:
Sas Piping _ Shutters
Sprinklers ElGenerator
_ S Ft. of First Floor: _
Utilities:SewerSeptic
Windows/Doors
Roof Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Ray Nettles
Name: Ivan Tones
Address: 9815 S Ocean Dr
Company: Safe Electrical Contracting Corp
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No.
Address: 1014 Plaza Dr
City: Kissimmee State: FL
Zip Code: 34743 Fax:
Phone No. 407-914-3116
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: ivantorm(ahotmail.com
State or County License: Ec-0002434
IIIf value of construction is $2500 or more, a RECORDED Notice of Commencement is required. II
V
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
City:
Zip: -
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
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.
no representation that is granting a permit will authorize the permit holder to build the subject structure
any.applicable Home Owners Association rules, bylaws or and.covenants that.may restrict or prohibit such
It 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 inspecti�} If tew�obtain financing, consult with lender or an attorney before
commencing work ogA r rig your_ntice� of<ommencement.
11
� -7
Signatu(of Ow L s ontractor a ent for Owner
Signature o ontra or/License Holder
STATE OF F RIDA
STATE OF FLORIDA
Orange
COUNTY OF 'S
COUNTY OF
The forgoing instrumentwas acknowledged before me
The forgoing instrument was acknowledged before me
thisdayof20by
this 5th day of March 2018 by
V)-e 4G-k-f
Ivan Torres
Name of erson making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification X
Type of Identification
Type of Identification
Produced--"'- - - --- " - - '- -- -
Produced -FL1D- -- -- - - -
i
ign'atur fNotaryPublic-StateofFlorida)
(Signature of Notary Pub"-S,o;Flaric!MICHARDDILORENZO
....
* * MY COMMISSION 9FFW21
Commission No. 44- -°": DOLORES(62®QBENEDIOTI$
Commission No.®E�:August 2,2019
-" MY COMMISSION #FF1t1733g�,
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�oPd' Banded Thru Sutlyel Notary Servues
'•??band' EXPIRES January 6, 2019
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Rev.8/2/17