HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION
ro BE ACCEPTED
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Date: /i/� % _
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�- Building
Planning and Development services
Permit Num
ermitApplicatio
3
NOV 28 2016;-
Permitting Department
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578- -.;' Cpmmercial
St. Lucie County, FL
Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 113 ' ISLAND DUNES COVE SCANNED
Legal Description: Lot 6 Las Tortugas at Hutchision Island _.._a ,
Stcie �,ourny
Lucie
Property Tax ID #: 3534-503-0007-000-2 Lot No. 6
Site Plan Name: Mitchell O'Neil Block No.
Project Name: Ivan Residence Fence Permit
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
itiona wor to e ertormea un ert ispermit-check a apply:
�HVAC Gas Tank Gas Piping _Shutters ❑ Windows/Doors
OEI ctric Plumbing Sprinklers Generator 1 Roof Roof pitch
II rI Cct� �p 0 a r
iotal-sq of Constru tion: _ T S Ft. of First Floor:
Cost of Construction; $ 15gD • Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Robert Ivany .W' MArianne Ivany
Name: _T2,ar-i �✓-(�S c .
Address:113 Island Dunes. Cove
Compa f x'e w—ks
City: St .Lucie County,State:_
Zip Code: __;.,___Fax:,'
Addre�K__IPII 'e. c�m ac
cl
City: 'State: r _
Zip Code:. 3+:iA:(- Fax:
Phone No.
E-Mail:
Phone No. —181-_ I (s I [,-
E-Mail: _ _ CS-�-r am F' -WJn Vs Inc.. C or"
Fill in fee simple Title Holder on next page (if different
State or County License: C& C I s 1 110 y 5
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
TOOL -O
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNE ENGINEER:-, ,; 'Not Applicable
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MORTGAGE COMPANY: of Applicable
Name:; . Ar.. (G
Name:
Address)a�'7 PJ - A(+-. kl* L I
Address:
City:States
City: State:
Zip: "Phone f . —III 3
Zip: Phone:
FEE'SIMPLE'TITLE HOLDER: I ' of Applicable
BONDING COMPANY: _ t Applicable
Name J
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 Court tNy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
is in
which 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as gent for Owner
Signatu Contractor/License--.HoldRr
STATE OF FLORIDyp�,
STATE OF FLORIDI.y) r
COUNTY OF 'JIIJ�i�
COUNTY OF 1
The forgoing instru nt was cknowledged before me
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The %Woing inst�uirg nt was ai;knowledged before me
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thisday of 20by
this! _dd of .20«by
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son making statem t
Name' f ers making statement
ersonaily Know OR Produced Identification
Personally Know OR Produced Identification
o entifiication
Type of Identific Ion
Pr ced
Produced
(Signs ure of Notary Publi - of Florida)
(Signature of Notary Public -State Florida )
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Rev.8/2/17