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ALL APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED in
Date: (;® Permit Number:-ljU���
Building Permit Application per �Feo �� Fo
Planning and Development Services
Building and Code Regulation Division SC n9 p �®
2300 Virginia Avenue, Fort Pierce FL 34982 Gt/_P �Da ,�
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential °j' e")e
PERMIT APPLICATION FOR: Renovation
Address: 8600 S. Ocean Drive, PH2 & PH3, Jensen Beach, FL. 34957
Legal Description: REGENCY ISLAND DUNES TWO UNIT PH-2 (OR 3536-360) and
REGENCY ISLAND DUNES TWO UNIT PH-3 (OR 4006-156)
Property Tax ID #: 3534-502-0068-000-4 and 3534-502-0069-000-1
Site Plan Name:
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
Cut Opening in Shear Wall Between Units PH2 and PH3.
Lot No.
Block No.
Aditional work to be
OHVAC
0 Electric
ertormed
E]
under tnis permit — check all
Gas Tank Gas Piping _
Plumbing Sprinklers 0
apply:
Shutters Windows/Doors
Generator 0 Roof
0
Total Sq. Ft of Construction: 10 sq ft
Cost of Construction: $ 500.00
Name Geoffrey R and Sharon M Seiber
Address: 3405 Clear Fork Trl
S Ft. of First Floor: _
11 Utilities:Sewer Septic
City: Fort Worth State: TX
Zip Code: 76109 Fax:
Phone No. 1-817-992-2174
E-Mail: gseiber@franfund.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Nathan Cooke
Building Height:
Company: Cooke Construction, Inc
Address: 1276 Business Park Place
City: Jensen Beach State. FL
Zip Code: 34957 Fax:
Phone No. 772-530-0659
E-Mail: nate@cookeconstructioninc.com
State or County License: CGC1520585
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name: _
Address:
City:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
�;.
Not Applicable
State: _
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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 intendjto obtain financing, consult with lender or an atto ne efore
commencing work or recording v9w►` tice of Commencement.
_ Signature of Owner/ Lessee/Agent
of
STATE OF FLORI //, STATE OF FLORID ,G�
COUNTY OFr�J'"� COUNTY OF �`''"
The forgoing instrument was acknowledged before me
this WMday of 20 2 by
(Name
re of Notary Public -State of
Personally Kno OR Produced Identification
pe yoti ica ent;in Pr
Commission No. G G
Revised 07/15/2014
Noreyap`ublic - State of Florida
om�{ission # GG 24467
My Comm. Expires Aug 25, 202,
The four ing instrument was acknowledged before me
this Wayof !t" 20by
Personally Kn yv� OR Produced Identification
mission No.
WALTER D PAYNE II
Nota0eIRIJ - State of Florida
Commission # GG 24467
Bonded through National Notary Assn.
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