HomeMy WebLinkAboutBuilding Permit Application ALL APPLICfA,BLE, INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:J
® - EC E WE
Building Permit Application
Planning and Development Services OCT
9 1� 2016
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Luci �ounty, FL
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residehi%'T
PERMIT APPLICATION FOR: Demolition
PROPOSED IMPROVEMENT-LOCATION:
Address: 10701 S.00EAN DRIVE,JENSEN BEACH, FL 34957 LOT 677 VENTURE
Legal Description: VENTURE OUT-SECTION C-LOT 78(OR 3887-2350)
Property Tax ID#: 4511-805-0078-000-9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF'WORK:
REMOVE OLD CONCRETE PAD
CONSTRUCTION.INFORMATION:
itiona work toe nertormed under this permit—check a appy:
11HVAC 0Gas Tank ❑Gas PipingShutters Q Windows/Doors
MGenerator Electric Plumbing Sprinklers L Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 900.00 UtilitiesInSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Richard&LINDA S Puckett Name: MACK MATOS
Address: 105 SE Crosspoint DR Company: MEL-RY CONSTRUCTION
City: PSL State:FL Address: 10967 S OCEAN DRIVE
Zip Code: 34983 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: x 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 Notice of Commencement.
`7 '__7 s
Signatu of /Less e/ ntractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA 1 STATE OF FLORIDA
COUNTY OF [". 1.�7(��1=� COUNTY OF L1 )0,ff,
The fo going instr e t as acknowledged before me The for oing instr ent was acknowledged before me
this W day of 20 I by this day of 20 _11,9 by
MKJ�_ MRe'l, mjelq)s
m
(Nae of person acknowledging) (Name of person acknowledg'ng
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Id tification ✓ Personally Known OR Prodwed Identification
Type of Identification Produced entification Produced p•,�
`— ;\11111 -, KAREN S. NI LSEN
Commission No. ��'o��
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=v R= MY Commission Expires +o���.•�,<,,,:
a 12, 2 Commission # FF L7SEN7
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Revised 07/15/2014 ,;,;;;°r''� June 12, 2018
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DATE
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