HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLA,, PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED qq�
Dated Permit Number:
Building Permit Application
Plann1 g and Development Services SCANNED
Builds and Code Regulation Division ., By
2300 irginia Avenue, Fort Pierce FL 34982 Lucie coup
Phon . (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERM, iIT APPLICATION FOR: Renovation
[PROPOSED SED IMPROVEMENT LOCATION: ..
Addres 46 AQUA RA DR, JENSEN BEACH, 34957 -
Legal D 'scription: WINDMILL VILLAGE BY THE SEA-UNITTWO- BLK A E 112 OF LOT 7 (OR 1766-4)
4511-811-0008-000-7
Prope ilk Tax ID #: Lot No.
Site Pla'l Name: Block No.
Project ame:
Setbac Front Back: Right Side: Left Side:
[DETA-1 ED DESCRIPTION OF WORK_ :
.CONST�UCTION
-INFORMATION:
IfflHo V
wor to e e orme under is permit - c ec a apply:
C �Gas Tank []Gas Piping Shutter❑Windows/Doors
I
s
El:
ric 5Plu-mbing ❑Sprinklers CGenerator Roof Roof pitch
I
Total Sq.,
t of Construction: l j �b S . Ft. of First Floor:
Cost of C
nstruction: $ Utilities: LyN Sewer 13 Septic Building Height:
OWNS.,"LESSEE:
�
CONTRACTOR: --
Name PI ULA KIERNAN
Name: TOD BATSON
Address: 4SD rd St--
Company: MOANA MANAGEMENT INC
City: State•��
Address: 3 PALMETTO DR
Zip Code's �4 `moo Fax:
City: STUART State: FL
Phone N S & l - i S -i - O 3 7 SS
Zip Code: 34996 Fax:
E-Mail: dW Mol C_o
Phone No. 772-828-9855
Fill in fee, imple Title Holder on next page ( if different
E-Mail: todbatson@gmail.com
from the ner listed above)
State or County License: CGC 1525290
if value of "construction is $2500 or more, a RECORDED Notice of Commencement is required
SUPLEMNTAL
CONSTRUCTION LIEN LAW INFORMATION;
DESIGNER/ENGINEER:
Name:
x Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
State:
Phone
Address:
Citj
Zip:
Address:
City: STUART State:
Zip: Phone:
FEE
SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Na
Adc
City.
e: PAULAKI£RNAN
Name:
Address:
City:
ress: 48 AQUA RA DR
JENSEN BEACH, FL
Zip:i
34957 Phone:551-767.0378
Zip: Phone:
ER/ CONTRACTOR AFFIOVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
y that no work or installation has commenced prior to the issuance of a permit.
e County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
Is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
re. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
rdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
owing building permit applications are exempt from undergoing a full concurrency review: room additions,
)ry structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
DING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
vements to your property. A Notice of Commencement must be recorded and posted on the jobsite
a the first inspection. If you intend to obtain financing, consult with lender or an attorney before
iencina work or recording our Notice of Commencement.
�II�I
Id
r
Slgndkure of Owner/ lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
sTA' E OF FLO�j IDA
STATE OF FLORIDA
CO TY OF RAM 620-ck
COUNTY OF C c
The f ?rgoing instrument was acknowledged before me
this l�I -y d day of N s QSk- . 2019 by
The for ding instru ent was acknowledged before me
this 20 , day of 20 1 V by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification r
Personally Known _X OR Produced Identification
Type', f Identification
Type of Identification
Prod ced P gA_,_&5 CVW-_ Uc,,24
Produced
(Sign
tore of Notary Pu •c Wlorida )DESIREE RIVERA
Signature of Notary Public- State of Florida )
Notary Public - State of Florid
Comrr
Ission No. ` +oQ (ffreBPission # FF 194627
'201
,,
°mmission No. ..,�►�� EDWA ��11
M Comm. Expires Feb 1,
la .,,�.�:... Y p
tarypublic- tateoiFlorida
Commission # GG 113982
�. My Comm. Expires Oct8,2021
roug a w
y sn.
REV
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SUPERVISOR
PLANS
VEGE ON
G OVE
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COUNTER
REVIEW
REVIEW
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DATA
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DATE1
COMPLETED
LETED
Rev. 8/?/17