HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t - 1 1- Permit Number:
Ike
09NNVOS
Building hermit 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: Mobile home
PROPOSED IMPROV,,.:.
EMENT LOCATION-.-.,,
Address:
Legal Description: NETTLES ISLAND INC
RECEIVED
JAN 1 1 2018
PT, Wglp county, Permitting
Residential X
Property Tax ID#: 45-0Z"-5D(- �3C-0—ow_,�T
Site Plan Name:
Project Name: I Nt Dim
AJ
Setbacks Fro ack: Right Side: o .> Left Side: q
�,'bETAIL E-DbESCRIPTION OF. WORK:
NEW 2018 MOBILE HOME
A 3'8 >� ;V, I 3a
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit- check a apply:
�HVAC L _I Gas Tank E]Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers 1:1 Generator E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ "2475 Utilities: Sewer O Septic Building Height: 13
,
OWNER/LESSEE:
°
CONTRACTOR:10
Name
l (� �
� l n l o n
Name: ,� ntn e
Address: I J -7 -3 8[o60
City: State: _
Zip Code: 34957 Fax:
Phone No. ���-C1 ��7?�
Company: TOMS MOBILE HOME
Address:'
City: State: FL
Zip Code: 34772 Fax:
Phone No. 8635292370
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: NANCYARMSTRONG61 @GMAIL.COM
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
L_
r�
SUPPLEMENTAL CONSTRUCTION.LIEN LAW INFORMATION:. ..
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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.
��.11L ✓v`��
C�AC�
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF -LUCIE
COUNTY OF D�_ CGL,r�
The forgoing instrument was acknowledg before me
The forgoing instrument was acknowledged/,�efore me
this 4 day of JAN 20IV by
this 4 day of JAN 20 �tJ by
EDDIE GRUNDEL
EDDIE GRUNDEL
Name of person making statement
Name of person making statement
Personally Known x OR Produced Identification x
Personally Known x OR Produced Identification x
Type of Identification
Type of Identification
Produced FLDL
P oduced FLDL
(Signature of NotVy Public- State of Florida )
(Signatur
ISP.",e NANCY MIMS ARMSTRONZi
Commissi IN J -`_ ION # F00mbg
Commission No. (Seal)
EXPIRES February 10.2019
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DATE
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RECEIVED
DATE
COMPLETED
tev. 8/2/17