HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,f J
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: 16 7 SCANNED Permit Number: / tQ n /,�/
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_. _11 BY RECEIVE®
St. Lucie Count/
Building Permit Application JUL 1 1 2016
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 Residential
PERMIT APPLICATION FOR: Concrete III
Address: 9650 S. Ocean Drive; Jensen Beach, FL 34957
Legal Description: The Princess Of Hutchinson Island
Property Tax ID #: 4502-610-0000-0006 Lot No.
Site Plan Name: Block No.
Project Name: The Princess Condo
Setbacks Front Back: Right Side: Left Side:
Concrete Repairs P v-fr°1 1kP4-1 rrCPU'' evcJ 56A KC"Wr 0^ d
`s CONSTRUCTIONINORM
iiona wor toe a orme under tis perm—c ec a apply:
[1HVAC f]GasTank ❑Gas Piping Mutters
,
a
❑Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ Kk I g i �� Utilities: Sewer oSeptic Building Height.
,OWNER/LESSEE;;
b>5'". ` .'us ,u k� +
CONtl;RACT R�
^Name:
Name The Princess Condo
Patricia Salazar
Address:9650 S. Ocean Drive
Company: Daniello & Associates
City: Jensen Beach State: FL
Zip Code: 34957 Fax:772-229-7799
Phone No.772-229-9690
Address: 2708 N. Australian Ave, Suite 9
City: West Palm Beach State: FL
Zip Code: 33407 Fax: 561-833-3573
Phone No. 561-835-4788
E-Mail:
Fill in fee simple Title Holder an next page (if different
from the Owner listed above)
E-Mail: info@ConcreteRepaidng.net
State or County License: CGC-1618181
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION: '
DESIGNER/ENGINEER: _ Not Applicable
Name: CSMEngineem
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 1235 S.E Indian St Suite 103
Address:
M
City: Stuart State: FL
Zip: 34997 Phone: 772-22o45o1
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
K
City:
City:
Zip: Phone:
Zip: Phone:
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;
V\.2.P_
_ Signature of Owner/
STATE OF FLORIDA -� STATE OF FL9q c' -
000NTYOF ,.� COUNTY F -tLlT3a
The forgoing instrument was acknowledged before me The for og 'iainstrument was acknowledged before me
thi&9 day of 201�by this yS day of _�, 0 ( (—r 20 l b by
��. '_DL?WVA-y' VP
(Name of person acknowled ing) (Name
Notary Public- State of Florida
Personally Known X OR Produced Identification
Type of Identification PQ&lIjrred
Commission No.
Revised 07/15/2014
t`
Personally Known _/A/- OR Produced Identification
Type of Identification Produced
TIMOTHY D. ERICKSON
MYCO40W*N#FF138841 Commission No.
EXPIRES: October 31. 2018
Bonded ThN Notaryi utiicUndenvdtere
POLO
FF 105833
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