HomeMy WebLinkAboutJenkins Rd permit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 a i Permit Number:
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) 452-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
L PROPOSED IMPROVEMENT LOCATION:
Address
Legal Description: b y Qi t It C71C\? I C)F NUJ -
'_
L-2 S k j 0 44
Property Tax IQ #:dQ) Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Flight Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Block No.
CONSTRUCTION INFORMATION:
A itiona wor to a er orme under this permit -check a appy:
HVAC Gas Tank 0 --as Piping n Shutters. Windows/Doors
Electric Plumbing ❑Sprinklers Generator ORoof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ � Q . 0(z)
SFt. of First Floor: _
Utilities: Sewer OSeptic
Building Height:
OWNERILESSEE:
CONTRACTOR:
Name f U iC t
Name: < Gi � L�i l�t� L -L-,-/
Address:
Company: e_nez kA urtit i(Q i
City: State: 1-
Zip Code: � Fax:
Phone No. _2� - ?t> - C) J
E -Mail:
Address: 9 ��[� _SSG l'p_
City: C C E? - - State:
Zip Code: 3 Fax. --7-7J -3W- 2_69(3
Phone No.`I -1 DL - 63-1 3 y$ 2 -
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: c2eneSrJ�u b i narSen} -f°I �f 1
State or County License:
IT value or construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name.
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
State:
— Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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 pians, 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, wails, 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 your Notice of Commencement.
Signature of Owner/ sEe_Contractor as Agent for Owner gnature of Contractor/License Fr Ider
STATE OF FLORIDA
COUNTY OF t_
The forgoing instru ent was acknowledged before me
this .5 day of `Ue -V , 20 iq by
(Name of person acknowledging)
(Sign atu"re of Notary Public- State of Florida )
y :. `;.:'"3 Pr�Id�lei�PtHtRZ
Personals Known •,*
Type of Identificati r { Comm"anion # GG 97150
°ty y ommission xpi
�„*;�� Apri 24 2021
Commission No.
Revised 07/15/2014
STATE OF FLORIDA F,
COUNTY OF K
--'
The for oing instrument was acknowledged before me
this 3 day of 20 � 9 by
l�Ck. Lz
(Name of person acknowledging }
(Signature of Notary Publsc-�tate of Florida }
Personally Known -'. °":".'�b1,; PrcoUMA9sLeJY11,111
Type of Identificati°o ` d Commission # GG 97� 50
My Gomml9SLOR xpires
;•<,,��a.� ,gprsi �a21
Commission Na R�"+��+ °�°`
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