HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r0 Permit Number: 1c, 6yA
ECEI v'ED APR 0 7 2016
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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 -�h, �,•
PROPOSED IMPROVEMENT LOCATION:
Address: 22 r,a Puerta del Norte Fort Pierce
Legal Description: East ? of Section 1 Township 34S Range 39 E less North
1n69 _ 5_9_' lying Nnrth R West c)f Tlirniike Feeder Road_
Property Tax ID#: 1301-111-0001-000/5 Lot No.
Site Plan Name: Block No.
Project Name: Spanish Lakes Country Club Village
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Install screen infill rear lanai and front entry.
[CO:N:STRUCTION:'].N.FORMATION..
Additional work to be performed under t ispermit—check all t apply:
E1HVAC Gas Tank Gas Piping Shutters �Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 2, 200 .-00Utilities: Sewer Septic Building Height:
OWNE,:R/LESSEE 'k . TRACT.pR _ k
s,
Name_ Christine Sullivan Name: Jeff Jackman
Address: 22 La Puerta del Norte Company:Master Craft Aluminum Product
City: Fort Pierce State: FL Address:1634 SE Niemeyer Cir.
Zip Code:34951 Fax: City: Port St. Lucie State FL
Phone No._51 0-8rj_r;n71 Zip Code:. 349;2 Fax: 335-0866
E-Mail: Phone No. 335-1177
Fill in fee simple Title Holder on next page(if different E-Mail: mastercraftal umi num(agmai 1_com
from the Owner listed above) State or County License: SCC131150586
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 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 Notice of Commencement.
i s
_Sig a' r of`%0`11-e� gent Signa ur o Co\ icense Ho er
STATE IDASTATE { FLO IDA
COUNT St. Lucie COUNTY OF St. Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 5 day of April 20 Eby this_-day of Apr i 1 ,20 16 by
Jeff Jackman Jeff Jackman
(Name of person acknowledging.) (Name of person acknowledging)
GL/• /��'� �/L��Gil/.
(Signature of NotaryPublic-State of Florida) (Signature of Notary ublic-State of Florida)
Personally Known X OR Produced' fic�F�ryiD.Moore Personally Known X OR-Produced Identification
Type of Identification Produced NOTARY ype of Identification Produced_ AiMarry
STATE OF FL IDA y AI�Y PUBLIC
Commission No. Com #FFg4 Zommission'No. AN, S��er�bF FLORIDA
Expires Ili 5/19 020 :"'Camn .FF�LQ362
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS