HomeMy WebLinkAboutAPPLICATION Tsuda HIMPACABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: WPermit Number:
•
1BAdi n4l PeRit A&1ic1tid%
Panning and Development Services
Building and Code Regulation Divisiorm
2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: 462-1553 Fax: (772) 462-15786 Commercial Residential
(772)
ERMIT AP LICATION OR: Window/door
Address: 10680 SS Ocean Dr Apt 202 Jensen Beach, FL 34957
eg�rip o
ISLAND CREST CONDOMINIUM UNIT 202 AND UNDIV SHARE IN COMMON ELEMENTS (OR 3006-1684)
Property Tax ID #: 4511-516-0019-000-1 Lot N .
Site Plan Name: lock No.
et ac ront ____�ack: _ �igide: Lide:
'DETAILED DESCRIPTION OF WORK:
F3 lace 2 �lidj�g gl s d 2 "c pIct gl rs
• • • •
CONSTRUCTION INFORMATION:
Additivial wor to a er und this p rmit - eck all ap
aHVAC Gas Tank *Gas Piping Shutters ❑ Windows/Doors
_
• 0 ❑ Generator llfhoofAF7 Roof itc
�E ❑ �S
ri mb' g� rinklers
40
Total Sq. Ft of Construction: _ S Ft. of First Floor. _
oSfofCo•trIcti 15,290 Utilities w�r�Se ti-Buildinlei ht:-
- - - - _ _
,OWNER/LESSEE:
CONTRACTOR:
Name Hirohiko Tsuda
Name: Janet Milici
Company: Natural Flow, Inc
Address: 391 NE Baker Rd.
_
Address: 10680 S Ocean Dr Apt 202
City, Jensen Beact State: FLU
Zip Code: 34957_1`ax: -
City: Stuart*State: F�
Phone No. 786-683-28560
Zip Code: 3499400 Fax: 772-334-1078
E-Mail: Tat0807@gmail.como
Phone No. 772-334-1011
II in fee simple Title Holden next page ( if different
#rom
E- il: Janet@naturalflow.net
SCC 131151263
the Owner listed above)
Stake or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGIy�R/EN4EEJ: -_ N tAppl�ica MORTGAGE COMPANY:- Not Applicable
Name. • Name:
Address: Address:
City: State: City: Sta e:
Zips Phone Zip: Phone:
FEE SIMI
Name:_
Address:
City:
Zio:
LE TITLE HOLDER:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicatec
I cerr ' thhno ork or installation has commenced prior toothniss an e o a p rmiSt. Lt�Te Ca[Tnty a <es no repr-n'faiion tha ii' s g�'nting a ptIIthrizthermit 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 suc�
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 ccor n withOerm
appro dppl ns, thg Fl a ilding Codes g nd Lucie Co ty Amendts.
T foll in b diitlic ion re em t from under oin full concu en room additions, -
accessory structures, swimming pools, fences, walls, signs, screen rots and accessory uses to anothetoon-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 S1
,Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consul
with lender or an attorney before commencing work or recording your Notice of Commencement.
Signatur of own / Lessee/Contractor as Agent for Owner Signatu e of Co ractor/License Holder
IRT1O ORR • ' I•I • �T OF FLO9:
• •
COUNTY OF T� N COUNTY OFJWW
Sworn to (or affirmed) and subscribed be ore me of Sworn to (or a firmed) and subscribed be ore me o
Physical Presence or Online Notarization ,I X Physical Presence or Online Notarization
this � day of by_ day f ��cCM.3E2 �b�
Name of person making statement. Name of person making statement.
dollPersona y Known _� Produced erl ication , Persona y nown %� • O o e c o Dn
Type of Identification_ • Type of Identification
Produced Produced
(Signature of Notne Hall
�r/y�-n1 bli�State of Florida) Si nature of Notaiv/_t Iic- 5t o{ nda�otwy Public State of FI
4V 1 5 0 � —,%Is ry Public State of Flo • �,v� 5� =,J ,,���� (fin Mmmna aasion GG 207
C mmission No. y1 e cm is ion o. 9A�eIt7 -
Donna Jayne Hall Vy� Expires Ou15/202
My Commission GG 207555 • _ _ _
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REVIEWS FRONTG SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVF
COUNTER REVIEW REVIEW REVIEW- REVIEW • REVIEW •
DATFE • • • • • • • • • • •
RECE E
DATE • —�— _� • • —
COMPLETED