HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Si— � � Permit Number: 109 n1 {
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B ildin P u li i u _ g r e , p catno
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 F;OR: General Building Permit and Windows & Doors
T LO PR®POSEDIM=PR01/EMENCATIQN �Yry � �
Address: 5705 PALEA PINES CIR, FORT PIERCE, FL 34951
Property Tax ID#: 1312-500-0020-000-2 Lot No. 19
Site Plan'Name: Block No.
Project Name: JACQUELINE FOSHAY-TIMBERLINE
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D AILED DES-eRI ®N�OFWORK � � O
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FLORIDA REBUILD PROGRAM - DEO/CDBG-DR'PROGRAM-RELATED
SIZE FOR SIZE WINDOWS AND DOORS REPALCEMENT, REPLACE CABINETRY, SOME,
DAMAGED DRYWALL, FLOOR CAOVERING, INSULATION, PAINTING.
New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas;Tank _Gas Piping _Shutters V Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq.-Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 5,241'.75 Utilities: —Sewer —Septic Building Height:
OUI/NERJLESSfE - CONTRA
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Name FOSHAY,JACQUELINE D Name:VICTOR LEONI
Address:5705 PALEA PINES,CIR, , FL 34951 Company:BUILDING CONCEPTS OF FL INC
City: FORT PIERCE State: FL Address:7650 W 26TH AVE
Zip Code: 34951 Fax: City: HIALEAH State:FL
Phone No.832-642-3181 Zip Code: 33016 Fax:
E-Mail:JENNY@DEEPSOUTHRECOVERY.COM Phone No 832-642-3181
Fill in fee simple Title Holder on next page(if different E-Mail JENNY@DEEPSOUTHRECOVERY.COM
from the Owner listed above) State or County License CBC031847
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.
SUPPLEMENTAL CONST------ 10N LIEN LAW INFOR1kl1ATl�`
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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. 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 aaaUQrney before commencing work or recording our Notice of Commencement.
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(Signatur - I., wnerj:LesseejGnntractor:as Agent:fpr Owner} SignatureTMgf q µ ractorjLicense Hold
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St. Lucie COUNTY OF MIAMI-DADE
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed_before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this 13 day of APRE 2020 by this 23 day of JULY— 2020 by
JACQUELINE FOSHAY Victor Lem
Name of person making statement. Name of person making statement..
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification V
Type of Identification Type of Identification
Produced Driver License Produced Driver Lic s
(Signature of Notary Public-Stat Signature of Notary Pub ic- to
Notary Pubft Soft of FlWft auaK spa.a
.Commission No. GG239420 ( C otiGG239N20 ommission No.brieloczabsGG239420 czes�m
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
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COMPLETED
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