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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date:`6��4 10 -) Q ` 14 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: f3pR ng
Address: 2019 Nettles Blvd.
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Residential x
Legal Description: Nettles Island Inc, A condo -section I Parcel 19 and pro-rata share in common elements(or 415-964)
Property Tax ID #: 4502-501-0022-000-1
Site Plan Name:
Project Name:
Setbacks Front /0
0.5
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Back: Right Side: 9t Left Side:
Remove old trailer and build new CBS single family home.
Lot No. 2019
Block No.
Haa tonal work to bje nertormed under this permit— check all apply:
rVAC L_J Gas Tank []Gas Piping _ Shutters 2fwindows/Doors
Electric E�_ Plumbing Sprinklers M Generator 11 Roof
Total Sq. Ft of Construction: ` ,;3 l 7 S . Ft. of First Floor: 114�1 Z<
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Cost of Construction: $ 19. Utilities: IzSevverF Septic Building Height:
Name Thelma & Howard Williams
Address: 2019 Nettles Blvd.
City: Jensen Beach State: FL
Zip Code: 34957 Fax: Phone No. Z Z- D q 9 — 1 S__49S_
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Mack Matos
Company: Mel-Ry Construction
Address: 10967 S. Ocean Dr.
City: Jensen Beach
Zip Code: 34957
Phone No. 772-229-9439
E-Mail: Mack@mel-ry.com
State: FL
Fax: 772-229-9440
State or County License: 23630
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
w i 14 0
DESIGNER/ENGINEER: _ Not Applica
Name: John H. Creswell
Address: 4459 SE Kubin Ave.
CItV: Stuart
Zip: 34997 Phone: 772-215-0156
State: FL
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:
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
commencind-work or recording vour Notice of Commencement.
*S61T0re Owner/ Agent/ Lessee
Signature Holder
of
of ontractor/License
STATE OF FLORIDA I
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STATE OF FLORID C�
COUNTY OF UU�: IG
COUNTY OF ,
The�orgoing instrument was acknowledged before me
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The fRrgoing instr en was acknowledged before me
this of 20� by
this—) day ofi 20 by
_day
wl � U,(�i
(Name of person acknowledging)
(Name of person acknowledging )
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(Signature of Notary Public- State of Florida)
(Signs ure of Notary Pub c- Stat of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
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Commission Ncxy-4 UP-4.0 N(WOublicStateofFlorida
W MILONE
ommission No. ,��tPl�-I '{�
Notary 1�1�1ig/ State of Florida
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Christine Matos
My Commission EE 224190
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=' « MY Comm. Expires Mar 22, 2017
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Revised 07/15/2014
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Bonded Through National Notary Assn.
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