HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _` A Permit Number: t 1 I Lp RECEIVED
Building Permit Application OCT 2 4 2W
Planning and Development Services 9 PERFJIITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:��-Q
Address: 2152 Nettles Blvd, Jensen Beach, FL .
Legal Description: NETTLES ISLAND INC, A CONDO -SELECTION I PARCEL 152 AND PRO RATA SHARE IN COMMON
ELEMENTS (OR 3748-110)
Property Tax ID #: 4502-501-0155-000-2
Site Plan Name:
Project Name:
,Setbacks Front Back: -
Right Side: Left Side:
Lot No.
Block No. .
IITear off existing shingle roof, install 'new underlaymeht, install accessories and metal panels
❑HVAC LJ Gas Tank ❑Gas Pi
❑ Electric ❑ Plumbing ❑Sprinl
Total Sq. Ft of Construction: 1100
Cost of Construction: $ 3500.00
ng ❑_ Shutters ❑ Windows/Doors
ors ❑ Generator 21 Roof Roof pitch
S Ft. of First Floor: 1100
UtiIities:cnSewer ❑Septic Building Height: 12
OUVNE:RILEdS°SEE:
CONTRACTOR:
Name Q�C,
Address: M
City:-L%,Y\C..,OYW kA\-e_. Stater
Zip Code: OG0g'J Fax:
Phone No. g�h�-gO.3l�
Name:-TyP,0 . 0 C7-
Company:_IMP�L 12Q(:5—" i C:,) 5 1 STtV Y S
Address: 3X4 5e DQPM CV1 Te e
City: 5luR�_17 State: 1�.
Zip Code: 3 q �l�'- Fax b4.1- 93
PhoneNo.��
E-Mail: " .\ 1'1 5v s2'► s-.Yi
E-Mail: 91iIZQ _ -kCz«iiY1:U5V� e%;S-�1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or ounty License: G ( -3 �0 -g
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applica
Name:
Address:2152 Nettles Blvd, Jensen Beech, FL
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
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.
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 your paying twice for
Improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement. i
of Owner/ Lesse�onf�r as Agent for Owner
STATE OF.I
COUNTY O
Contractor
STATE OF FLO
COUNTY OF
i �o� instrument was acknowledged before me The f r� instrument was acknowledged before m'e
isd� ay of ( �, 20 by this 'May of Tpe �, 201a by
Name of person making statement Name of per o making statement =a''
-rsonally Known OR Produced Identification Personally Known OR Produced Identificatio•
(pe of Identification Type of Identification
•oduced Produced R1
x
a
55. 0
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;ignature of Notary Pu li State of Florida) (Signature of Notary P bli - State of Florida) o
)mmission No. 3�P (Seal) Commission N 1 (4 (Seal) �
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REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17