HomeMy WebLinkAboutBuilding Permit ApplicaitionALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I� v Permit Number: — 6'� D ,-I
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Mold RecerveL
Building Permit Application D 15 ?mF
Planning and Development Services /Al
itting uepartt
Building and Code Regulation Division t. Lucie Count
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
Address: 4681 Jorgensen Rd, Ft Pierce, FL 34981
Legal Description: WHITE CITY S/D 05 36 40 N 130 FTOF S 150 FT OF N 660 FT OF W 335.85 FT OF E 355.85 FT
OF NE 1/4 OF NW 1/4 OF NE 1/4 -LESS S 10 FT OF E 10 FT- (1.00 AC) (OR 1194-1089)
Property Tax ID #: 3403-502-0128-210-5
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
Reroof- Remove existing roof covering, dry in with self adhering underlayment and install new asphalt
shingles.
CONSTRUCTION INFORMATION:
CONTRACTOR:
Name Mark & Anastasia Johnson
Name: Michael Miller
Address: 4681 Jorgensen Rd
Additional work to be
Derformed under
this permit — checkall
apply:
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
HVAC
Gas Tank
0Gas Piping
_Shutters
Windows/Doors
11 Electric
❑ Plumbing
❑ Sprinklers
❑ Generator
❑
Roof I Roof pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction:
$ 16,250
Utilities:
Sewer Septic
Building
Height:
OWNER/LESSEE:
CONTRACTOR:
Name Mark & Anastasia Johnson
Name: Michael Miller
Address: 4681 Jorgensen Rd
Company: Trade Winds Roofing, Inc
City. Fort Pierce State: FL
Zip Code: 34981 Fax:
Phone No. 772-370-7040
Address: P.O. Box 13208
City: Fort Pierce State: FL
Zip Code: 34979 Fax: 772-466-9725
Phone No. 772-466-9420
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: Mike@tradewindsroofing.com
State or County License: CC C057399
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:_
Address:
City: _ State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
_
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
commenciu work or, recording vour Notice of Commencement.
Signature of Owner/ Lessee/ContracAr as Agent for Owner I Signature of Contractor/License Ho(tier
STATE OF FLORIDA- - ll 'STATE OF FLORID
COUNTY OF l/�� C �� COUNTY OF +�
The forgoing instrument wascknowledged efore me
this day of �'1��L 20j�by
Name of person mong statement
Personally Known OR Produced Identification
Type of Identification
ture of Notary Public- Sta
Commission No.
:elf Florida
Felicia Lyne Wilkin
MPTARY PUBLIC
STATE OF FLORIDG
Comm# GG103861)
REVIEWSI FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The forgoing instruTnent was acknowledgo before me
Cl -
this day of rAr Oh 2 by
`� l C Ck_Q_ 1 V)--� ( I U- K.
Name of person making statement
Personally Known "-, OR Produced Identification
Type of Identification
Prod ced
1 Cl (�
(Signature of Notary Public tate Florida )
Felicia Lyne Wilkin
Commission No. P%&WTARY PUBLIC
STATE OF FLORIDA
L Comm# GG103860
SUPERVISORPLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW