HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Laa IS Permit Number:
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RECEIV-D DICT 019. 2015
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 Residential X
PERMIT APPLICATION FOR: Demolition
PROPOSED IMPROVEMENT LOCATION:
Address: 40 NETTLES BLVD,JENSEN BEACH, FL 34957
Legal Description: NETTLES ISLAND INC,A CONDO-SECTION II PARCEL 40 AND PRO-RATA SHARE IN COMMON ELEMENTS(OR 317-782)
Property Tax ID#: 4502-501-0226-000-1 Lot No.40
Site Plan Name: Block No.
Project Name: LASH
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
REMOVE OLD CONCRETE RV SLAB
[CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit—check all t1lat appy:
HVAC Gas Tank ❑Gas Piping _Shutters l__.3 Windows/Doors
❑Electric ❑Plumbing Sprinklers F]Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 1,500 Utilities:7Sewer Septic Building Height-
OWNER/LESSEE: CONTRACTOR:
Name Sidney&Ann Lash Name: MACK MATOS
Address:PO Box 518 Company: MEL-RY CONSTRUCTION
City: Wharton, NJ 07885 State:NJ Address: 10967 S OCEAN DRIVE
Zip Code: 07885 Fax: City: JENSEN BEACH State:FL
Phone No.772-229-0012 Zip Code: 34957 Fax: 772-229-9440
E-Mail: Phone No. 772-229-9439
Fill in fee simple Title Holder on next page(if different E-Mail: MACK@MEL-RY.COM
from the Owner listed above) State or County License: 23630
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: x Not Applicable
Name: Name:
Address: Address:
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 thepermit 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 our Not' f Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Co ractor/License Holder
STATE OF FLO A . STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgging.instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of D CV�- 20 Z,6"-by this AW day of 20 L�E by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type I, c-atien-R - Type of Identification Produced
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