HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED cy
Date: ��b \ �� Permit Number: (56-6 �1
RECEP' D JUN 08 20116
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 XXXXX Residential
PERMIT APPLICATION FOR: Window/door --
PROPOSED IMPROVEMENT LOCATION:
Address: 9500 South Ocean Drive, Unit 1503,Jensen Beach, FL 34957
Legal Description: Islandia II Condominium Unit 1503 (OR 3819-834, 836)
Property Tax ID#: 4502-602-0137-000-0 Lot No.
Site Plan Name: Block No.
Project Name: Blotnick residence
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: �
Replace Sliding Glass Doors and Windows with Impact Glass
CONSTRUCTION_ INFORMATION:
Additional work toe e orme under t —checkispermit a t a appy:
11HVAC Ei Gas Tank ❑Gas Piping In Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �QO.C3C�1 Utilities: Ir(Sewer Septic Building Height:
OWNER/LESSt"F: � ° �CONTRACTOR. .
Name David Blotnick Name: D(A\lid LaPracie
Address: 9500 S Ocean Drive,Unit 1503 Company: 1-)11' GIaSS PfOfessioilcr.)S
City: Jensen Beach State: FL Address: 3570 56 bixie 44wU
Zip Code: 34957 Fax: City: 5"ny-A- State: FL
Phone No. 561.662.9989 Zip Code: 3"1 Fax: -i72•7-8b•0469
E-Mail: davidb@consultpr.net Phone No. -771•Z`k•O' 0
Fill in fee simple Title Holder on next page(if different E-Mail: rmi O1QSS�i'CS��,pnaa l CG'm
from the Owner listed above) State or County License: 193to3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
SUPRILEMENTAL CONSTRUCTION' LIEN LAW INFORMATION:.
DESIGNER/ENGINEER: xx Not Applicable MORTGAGE COMPANY: xx Not Applicable
Name: CharlesNRhein Name:
Address:632 East Drive Address:
City: Delray Beach State: FL City: State:
Zip: 33445 Phone: 561.239.1708 Zip: Phone:
FEE SIMPLE TITLE HOLDER: xx Not Applicable BONDING COMPANY: xx 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 Co ncement may result in your paying twice for
improvements to your property. A Notice of Comme ement st be record d and posted on the jobsite
before the first inspection. If you intend to obtain f'nancing, c It th nde or an attornPv before
commencing work or recording our Notice of Com encem t. t
_ s
--i 69natGre of Owner/tessee/Agent Sig re of Cont r License Ifolddr
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Marin COUNTY OF Martin
The forging instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20/4-by this 2 day of J(r)f .20 A, by
(Name of person acknowledging) (Name of person acknowledging)
t
(Sig turd of Notary Public-State Florida) (Signature of ary P - f ELLY WIDMAN
d��,pr PLB
N r Pub le•State of Florida
Personally Known OR Produced Identification Personally Known xx ? �S( ceglic Pub 92955
Type of Identification Produced Type of Identification P "y G-01M.M."EXPIF89 Get 20,2019
CYN RN#FF921123 TUNING �Rlot�► ftft (�g WW Notary Assn.
Commission No. �tb' Commission No.
MY CO
l EXPIRES:septmnW 23,2019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS