HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: • Permit Number:
Buildingformit Application MAR 2 3 2018
Planning and Development Services 11p1s riffo'
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 i Commercial Residential X
PERMIT APPLICATION FOR: Roof
PROPQSEO)WR�VEMENT LOCAT)ON
Address: 10726 S Ocean Dr Lot # 72 Jensen Beacli FL 34957
Legal Description: HOLIDAY OUT AT ST LUCIE BLK G LOT 33 AND EQUAL PRO-RATA INTEREST IN COMMON
ELEMENTS (OR 3499-1135)
Property Tax ID #: 4611-501-0243-000-4 Lot No. 33
Site Plan Name: Block No. G
Project Name:
Setbacks Front Back: Right Side: Left Side:
(::DETAILED DESCRIPTlON1OF WORK =� - .w
TEAR OFF EXISTING SHINGLE ROOF AND INSTALL NEW 5V MILL FINSH METAL ROOF
COiVSTRUCTION INFORIVIAT!ON
A tirfitinnn I taint to hat nnrF^rmnf4 i in rinr fi ie nnrm it _ r- hnr• n H + nt nnn v
0HVAC u Gas Tank
Electric Plumbing
Total Sq. Ft of Construction: 747
Cost of Construction: $ . 6,600.00
Piping " LJ Shutters
nklers 11 Generator
_ S Ft. of First Floor: _
UtilitiesnSewer Septic
11 Windows/Doors
RiRoof
Building Height:
WNER/LESSEE =
CONTRACTOR .
Name Cornelius and Patricia Van Leeuwen
Name: Ronald Latta
Address: 43157 HWY 3
-Company: Treasure Coast Concepts Inc.
Address: 3458 SW Pluto St
City: -Port Saint Lucie State: FL
Zip Code: 34953 Fax: 772-905.4910
Phone No. 772.777-8130
City: Wainfleet, ON LOS 1V0 Canada State: _
Zip Code: Fax:
Phone No._�� 905 . gqq • 1 i � 9 p)'
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: tcconcepts@aol.com
State or County License: CCC1330362
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
.SUPPLEMENTAL CQNSTRUCTION LIEN.LAW IN . RMATtON:• .
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY:" 'x Not Applicable
Name:
Name:
Address: I
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: x. Not Applicable
BONDING, COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City:
City: I
Zip: Phone:. I
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 nor epresentation 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,lsigns, 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 I " r or an attorne before
rnmmcnrino �ernrlr nr rarnrrlina uni ir. Nntirp Inf rnmmPnrement_ o
X .0
Signature of Owner/ Lessee/Contractor as Agent fo'I Owner
S re of n /License Hold
STATE OF FLOMM ov.� ;�v�-iT'
STATE -OF F(PODA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this �lfA day of Al AP-C, 4 .20 19 by I
I I
this _ day of . 2C by
' ILIAyo"J wwguwl3rJ
Name of person aking statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of identification i
Type of identification.
Produced.
i
Produced
(Signature of Notary Public -State of RoWa40ti A vetZ�
(Signature of Notary. Public -State of Florida )
I
Commission No. •W/A (Seal)
I
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
a
i
RECEIVED
DATE
COMPLETED
Rev. 8/2/17