HomeMy WebLinkAboutBuilding Permit Application/I.
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: RFrr, Permit Number: 1 `J��- �3 4 1
V tD FE924,,10
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 Residential x
PERMIT APPLICATION FOR: Building
PROPOSED IMPROVEMENT LOCATION:
Address: 10725 S OCEAN DR Jensen Beach, FL 34957 Lot 327
Legal Description: HOLIDAY OUT AT ST LUCIE BLK B LOT 37 AND EQUAL PRO-RATA INTEREST IN COMMON ELEMENTS (OR 1566-429)
Property Tax ID #: 4511-501-0082-000-7
Site Plan Name:
Prefect Name:
Se-tb`acks Front t Back:
DETAILED DESCRIPTION OF WORK:
build new two story home
Right Side: S/ Left Side: '1,
Lot No. 37
Block No. B
CONSTfJCTIO.N INFORMATION:
—Addrti wor. to easel r orme under this permit— check a apply:
AC LJ Gas Tank ❑Gas Piping _Shutters a indows/Doors
✓❑"'A
Electric Plumbing Sprinklers Generator _ Roof
offal Sq. Ft of Construction: [748
Cos of Construction: $ i(o6060
eS� F; , of First Floor: _
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Rtr RAR TLr_c�ULLFG" d
Name:
Address: )� 5 Uf. 4l'r�i7�19 _. �i'
Company: �)4
City: C 6, Stater
L
Address: 11ClrD 7� W. _/9/1�✓/�
Zip Code: 3l ,ea Fax:
City: �rin�3214: t'a Stater
Phone No.
r
Zip Code: 047 Fax:
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name: John Creswell PE 27002
Address: 4459 SE Kubin Ave
City: Stuart State: Ft_
Zip: 34997 Phone: 772-215-0156
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
_Not Applicable
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.
t-
STATE OF FLORIDA-'
COUNTY OF Tv
s
Signature of Contractor/License Holder
OF FLORIDA
CY OF
The fOlgoing inst , ent was acknowledgedixfore me I The forgoing in ument was acknowledged before me
this `t' day of Y4R(ZL 20 by this day of 20 by
�tA �ICVAI' �0(--k' V(VAV
(Name of person acknowledging) (Name of person acknowledgi
(Signature of Notary Public- State of Florida
.�t Pu lie teof,Florida
Personally Known o` U Riot t � 'ILcation
Type of Identification o m lssion EE 224190
Ofwo Expires 10/1212016
Commission No.
Revised 07/15/2014
(Signature of Notary Public- State of Flo
Personally Known OR Produced
Type of Identification Produced
Commission No.
(Seal)
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