HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '30� ('�6 f 7 Permit Number: 0ra(3 0 (3t{
r_*a xx _:=fi RECE1 y D MAR 0 7 2016
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:. To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1 Lagos del Nor For Pi r -P FL 34951
Legal Description: Spanish Lakes Country Club Vil:lacfe Leasehold Estates
OR 2389-639
Property Tax ID#: -13-@}m-5(}6--6$-64- — 130 - 11 -Dao I-4dd" rj Lot No.
Site Plan Name:_ Spani -,h T,ak -G .o in ryr Cliib Vi 1 1 ache Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
FDETAILED'DESCRIPTION'OF,W,,ORK. Install frons entry i.nfil1/screen
CONSTRUCTION INFORMATION:
Additional work to be Derformed under t ispermit—check all apply:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric ❑Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 750 . 00 Utilities: Sewer Septic Building Height:
_ -0alVfalEliESSfE:. _ . OTTf�AC�O -
Name .Tnhn R Sandra whiten )z Name:_Jeff Jackman
Address: 1 Lagos del Norte Company: Master Craft Aluminum Product
city: Fort Pierce State: FL Address: 1634 SE Niemeyer Circle
Zip Code:34951 Fax: City: Port St. Lucie StateFL
Phone No. 413-313-4322 Zip Code: 34952 Fax: 335-0860
E-Mail: PhoneNo._ 335-1177
Fill in fee simple Title Holder on next page (if different E-Mailmastercraf taluminum@amail.com
from the Owner listed above) State or County License: SCC 1 31 1 50 586
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: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x 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 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 our Notice of Commencement.
V U I ),e�_
s
S' natP' 'fVner/Lessee/Agent Sig ur ntr ctor/License Holder
ST TELIDA STAT O FL DA
COUF St. Lucie COUNTY OF St. Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2 day of March . 20 —�I� this 2 day of March 2o16 by
Jeff Jackman Jeff Jackman
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P ic-State of Florida) Sheryl D.Moore (Signature of Notary PAtiic-State 6f Florida)
NOTARY PUBLIC_ -- _ -
- —- P-Personally-sonally Known � OR=Pro$uc cC d Personally-Known — -P-gcomff
% on
Type of Identification Produced G'. ►GenwN 8 Type'°� T e of Identification UFFIMW
UC
RIDA
Commission No. •��, eal)E��1H Commission No.
ExplreSVIM=
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS