HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - REVISEDAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: JUNE 23, 2021 Permit Number: ________
Building Permit Application
Planning and Development Services
Residential xBuilding and Code Regulation Division Commercial ---------
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 372 NETILES BLVD., JENSEN BEACH , FL, 34957
Property Tax 10 #: 4502-501-0558-000-7
Site Plan Name: CHAFFIN/CINAGLIA
Project Name : CHAFFIN/CINAGLIA -SINGLE FAMILY RESIDENCE
I DETAILED DESCRIPTION OF WORK:
CONSTRUCTION OF A NEW SINGLE FAMILY RESIDENCE
New Electrical Meter-,,.c;.........l__Second Electrical Meter______
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit check all that apply :
i Mechanical Gas Tank Shutters ¥ Windows/Doors
Lot No. 372
Block No. ___
Pond
¥Electric t Plumbing
_ Gas Piping
_ Sprinklers Generator Y-Roof ____Pitch
Total Sq. Ft of Construction: _1,_9_48______ Sq. Ft. of First Floor: 938/1,010 SECOND FLOOR
Cost of Construction: $ 445,000.00 Utilities: XSewer _ Septic Building Height: ____
OWNER/LESSEE: CONTRACTOR:
Name SHARON S. CINAGLIAISCOTI D. CHAFFIN Name: MACK MATOS
Address: 1321 NETILES BLVD. Company: MEL-RY CONSTRUCTION, INC.
City: JENSEN BEACH State: -Address: 10967 S. OCEAN DRIVE
Zip Code: 34957 Fax: City: JENSEN BEACH
Phone No. 609-385-8218 Zip Code: 34957 Fax:
E-Mail: Scott.chaffin@comcast.neUSharonc216@gmail.com Phone No 772-229-9439
Fill in fee simple Title Holder on next page ( if different E-Mail MACK@MEL-RY.COM
from the Owner listed above) State or County License CGC059412
If value of construction IS 2500 or more, a RECORDED Notice of Commencement IS required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
State: FL
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: BRADEN & BRADEN Name: -Address : 417 COCONUT AVENUE. #2 Address:
City : STUART State: _FL__ City: State: _FL__
Zip : 34 996 Phone 772-287-8258 Zip: Phone '
FEE SIMPLE TITLE HOLDER: _ 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. Luc ie 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 perm it appl ications 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-res idential 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 attorne before com in work or recordin our Notice of Commence ent.
Signature of Owner/ L _ ssee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF--=.S__T. ~LU:...:;C-=IE_____________
Sworn to (or affirmed) and subscribed before me of
_x_ Physical Presence or __Online Notarization
this 23RD day of JUNE , 202+ by
MacK ADCLinS
Name of person making statement .
Personally Known _x__OR Produced Identification
Type of Identification
Produc "'t't'--_-:-rr---__-f--V-__
KATHLEEN GANNON
MY COMMISS~~~G 914400
i+-':'~~~-j~IRES:January 18, 2024
Bonded Thru NotaIy Public Unde!Wrilers
STATE OF FLORIDA
COUNTYOF_sT_. L_U_CI_E___________
Sworn to (or affirmed) and subscribed before me of
_x _ Physical Presence or __Online Notarization
th is 23RD day of JUNE , 202~ by
Mac~ ,A~ a±v~
Name of person making statement.
Personally Known _x__OR Produced Identification ___
Type of Identification
Produce 7 ______.....,....-fi-___
KATHLEEN GANNON
MY COMMISS~~ijG 914400
--I1~o=J!Ij,'t::-:',~.....,vPIRES: January 18, 2024
Bonded Thru NotaIy Public Underwriters
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REVIEW
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