HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: 005 - 009
UANNgU
BY
-St Lucie County
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
Rec4FIVEF,)
MAY oig 2018
Perrnitting Dep
St. Lucie artMent
county
Residential x
PERMIT APPLICATION FOR: Building t
(),n i4- /0 3 5, Qu-40 �r-
L
PROPOSED IMPROVEMENT LOCATION:1 -3 1
Address: 1072,6§. Ocean Drive, Jensen Beach FL
Legal Description: Holiday Out at St. Lucie Blk.K
Property Tax ID #: 4511-501-0298-000-4
Site Plan Name: Holiday Out
1&2
1, equals PRO—RATA interest in common elements (or 3802-2347)
Lot No. 103
Block No. K
Project Name: i
Setbacks Front/0 Back: RightSide: cla Left Side:
DETAILED DESCRIPTION OF WORK:
Building a new C S, single family home Lqcw
'5 C9 its
CONSTRUCTION INFORMATION:
Additional work to b rformed__u_nd_erMs;_ permit —check all apply,
0HVAC fl Gas Tank F] n -
@Electric Uplumbing Gas Piping Shutters W ndows/Doors
E]Sprinklers 171 Generator ffRoof Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
Cost of Construction: $ Utilities Sewer OSeptic Building Height:
OWNER/LESSEE: - I �
CONTRACTOR: I
Name Jerry& Kay Thiel
Name: Mack Matos
Add ress: 10725 S. Ocean Drive Lot #103
Company: Mel-Ry Construction, Inc
City: Jensen Beach — State: FL
Address: 10967 S. Ocean Drive
Zip Code: 34957 Fax: N / A
City: Jensen Beach State:FL
Phone No. 772-229-9439
Zip Code: 34957 Fax: N /A
E-Mail: Mack@mel-ry.com or teresa@mel-ry.com
Phone No. 772-229-9439
Fill in fee simple Title Holder on next page ( if different
E-Mail: mack@mel-ry.com or teresa@mel-ry.com
from the Owner listed above)
State or County License: 23630
If uniala _# :_ 'AftrAA __ ____ - — .. .
-
. '- — - - --- �1 - MULILMur %-ummencernent is requirea.
I SUPPLEMENTAL CONSTRUCTION, LIEN LAW INFORMATION: - I
DESIGNER/ENGI NEER: NotApplicable
Name: �)w�\ �KQ.dfA3
Address: L-in CbconuA R),60
City: tswcxe State:
Zip: -Phone -22-S8
FEE SIMPLE TITLE HOLDER: X—, Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: )S, Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certifV that no work or installation has commenced prior to the,issuance of a permit.
St. Lucie Count4i makes no representation that is granting a permit will authorize the permit holder to build the subject structure
whichisincon ct with any applicable Home Owners Association rule�, bylaws or and covenants that m estrict or prohibit such
ayhr c
structure. Please consult with your Home Owners Association and review your deed for any restrictions w h 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 wur Notice of Commencement. /0"
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA 7�
STATE OF FLORIDA
COUNTY OF _S
COUNTY OF
The f rgoing instrument was acknowledged before me
this 6 day of 4-0c'u- 20 by
The f9rgoing instrqment was acknowledged before me
this U day of Wk7,L 1 20 �b by
Name of pe making statement
T
Name of person making statement
V
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produceek
Pr6&med
77,7 ZT. FTERPSA I KAMERIK
TERESA L; KAME
6
6Xnure of ub RKid@&MISSION # FF22716
Wotky Public- State.s. WaA Y COMMISSION # FF,
UP11 SfJaY05.2019
Commission No. Z) a i,
rimmatte/df
V2 PIRES May 05. 2(
0 ission No. _2 (Seaw,
Nola-yservicexon'
7 39"8-0'53 ruidallolaysei vice cot
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVI-EW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
dla-1
RECEIVED
i(ir?"
DATE
COMPLETED
Rev. 8/2/17 -V \ Z"*'/