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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y 1 Date: Permit Number: \4 ' flTMs Building Permit ApplicationL'E EIVED Planning and Development Services Building•and Code Regulation Division o �.�1� 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Res Nn�Yt Per�s'Itting PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lineF_ g� Address: 919 JACKSON WAY FT. PIERCE FL 34949 Legal Description: COASTAL COVES-UNIT 1-LOT 25 (OR 3929-1558)- Property 929-1558)Property Tax ID#: 1423-802-0027-000-9 Lot•No. Site Plan Name: Block No. Project Name: . Setbacks Front Back: Right Side: Left Side: .Y**" 5x 2•�� „_ �,v �`.,"_'�; ,� ..3,..z>� g r�2 ¢�sYrXey �.. !s-�'. �`§ `4�.:kF'ic ��a+'-.w.vxY x�'Y49s� `st +d x�`7 .„ ��E�Ft^`;�?,�� F'`S�rEvK,�'�, COI\ITRJCTI©IiiNORIU� TIOIU ,� , 4F kF { a '^ +� {�``„ .,tea: �,. zn. •ua ,.�,r_r ,e.','*- �`-: �" F' Additional work to be nprtormed under this permit—check all appy: HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors R.Electric' 0 Plumbing 'Sprinklers' ElGenerator E] Roof Roof pitch Total Sq. Ft of Construction: . S . Ft. of First Floor: Cost of Construction:$ f t COD 00 Utilities:]Sewer Septic Building Height: p OWNEL�SDu � �CONTRACTO!R ;:^�W..,a ><x -{o -+'::s? s' t`�`,�e.'s�;kw`„.�Y.r,.,? .fir YFmu.Ukct,-,._, :.'•:r YT -',+tier. .c+ +m uta51.^`va .....-_;' '. F;; i`fi.,s. 101z'i"? � Name EDWIN P.WORTH` EDWARD.V BUSS Name: Addre'ss:919 JACKSON-WAY Company:BLUE STAR ELECTRIC LLC City: FT PIERCE State:F� Address:'?402 PLUMgSA LN'.'--: Zip Code: 34949 Fax: City: FT PIERCE.- State:FL Phone No.772-321-7217 Zip Code: 34951 Fax: E-Mail: Phone No. 772-360-5779 Fill in fee simple Title Holder on next page (if different E-Mail: BLUESTARELECTRICLLC@GMAIL.COM from the Owner listed above) State or County License: ER13015160-STC CERT 29279 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. 1 SUP�PLEM�xNTAI.�•nCONSTtt�� CTION�Ll.EN�Lfi►WFII�aFORMATIfJN, �� _` � p�"tY� �� �� � "����-� ��i �� Y;.5 .�" .• -.:_..x.� 2�v t ,r�'3-.a .�y T r� r`qtr. x'�.. � -. � z DESIGNER/ENGINEER: _ Nbt Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: - Address: Address: City: State: City: State: Zip: Phone Zip: 'Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: 4d d rens:7402 PLUMOSA LN 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 commen ' ork or recordingour Notice of Commencement. rat a of ner/ ssee/Contractor as Agent for Owner Sign r f C tracto /License H r "AreSTATE OF FLORIDA S ATE OF FLOR,DA COUNTY OF Sk. Lt),_Vo, COUNTY C_V-,� The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me . thisa d day of CSC 20� by . aQ this � day of ' Q c 20 by ��►�� �sS �� a c ;.o 'S 5 Name of person making statement Name of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identifi ation Produced Produced 1�L (Signature of Notary Public-State of Florida ) (Signature of Not 4... at o �IAAkIEGIVENS ~�? MY COMMISSION#GG 022623 Commission NoA_(r6a'z.da IEGIVENS, Commission No. EXPIRES:D( 16.2020 ION#GG 022023 '•,+�o J..q••'� d Thru Notary Pu c Underwriters Y COMMISS r 16 2020 s. EXPIRES' mblleUnderv+ntere :m;' •�= eon REVIEWS FRON SUPERVISOR PLANS VEGETATION -- SEATURTLE MANGROVE COLIN REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17