HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� " 7
Date: � .9 . D 19 � PSJ'b 9� SCANNED Permit Number: 19 10- Q \S7 1
VOV9 �. BY (aod VOL
\ St. Lucle County y1�yV Building Permit Application
Planning and Development Services
Building and Code Regulation Division 1
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMITTYPE: Sign
PROPOSED IMPROVEMENT LOCATION:
Address: 10978 S Ocean Drive
Property Tax ID #: 451233100020201
Site Plan Name:
Project Name: Courtyard by Marriott
DETAILED DESCRIPTION OF WORK:
one (1) monument sign
Cortretk �'%qn '+o FX',St"Vloi pf'MR(i F 12Gt(IG
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Lot No.
Block No.
Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 85.80
Cost of Construction: $ �'�0"
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Jencourt LLC
Name:Jeffrey Petersen
Address:1001 E Atlantic Ave Unit 202
Company: Interstate signcrafters
City: Delrey Beach State: _
Zip Code: 33483 Fax:
Phone No.561-279-9900
Address:130 Commerce Ro
City: Boynton Beach State: FL
Zip Code: 33426 Fax: 561-547-3842
Phone N0561-547-37
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailelopez@aisigncrafters.com
State or County License ES12000164
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW, INFORMATION:.
DESIGNER/ENGINEER: _ Not Applicable
Name: Chnsttan Langley
MORTGAGE COMPANY:
Name: NA
_ Not Applicable
Address: 1200 N Federal Hwy
Address:
City: Boca Raton State: FL
Zip: 33432 Phones-888-371-3113
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:NA
BONDING COMPANY:
Name•NA
Not Applicable
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 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 foll wing building permit applications are exempt from undergoing z II concurrency review: room additions,
accessorIstructures, swimming pools, fences, walls, signs, screen rooms a d accessory uses to another non-residential use
"WARNI TO OWNER: YOUR FAILURE TO RECORD A NOTICE Cit
MENCEMENT MAY RESULT IN YOUR PAYING
TWIG OR IMPROVEMENTS TO YOUR PROPERTY. A NOT COMMENCEMENT MUST BE RECORDED AND
OTH RENDER OR AN ATTORNEY BEFTHE JOB SITE BEFORE THE FIORE RST RECORDING O OU.NBi10E OF COMMENCEMENTNCING, CONSULT
INTEND TO OBTAIN
WITH
Signature of Ow r/ Lessee/Contractor as Agent for Owner
Signature f Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Palm Beach
COUNTY OF Palm Beach
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledgeq before me
this 22 day of October
by
this 22 day of October 20a by
Jeffrey Petersen
q,�20,�
Jeffrey Petersen
Name of person making state
Name of person making statement.
N°
Personally Known x O Ifctdiifl
Personally Known x OR Produced Identification
Type of Identification
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