HomeMy WebLinkAboutBuilding Permit Application Jan 1O1A. 12:34p Toussaint Electric
773'770'0806 p.1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01-10-2019 Permit Number.
ri 1(p
Building Permit Application WEIJ
Planning and Development Services
Building and Code Regulotion Division JAN 10 2019
2390 Virginia Avenue,Fort Pierce FL 94-982
Phone:(772)462-1553 Fax: (772)462-1,578 Commercial Residenti ��6 �County,Permittirp
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lin AgLck\.,
PROPOSED IMPROVEMENT LOCATION:
Address: 4641 Jorgensen Road FT. Fierce,FIL
Legal Description:
it. 3403-502-0128-100-1
Site Plan Name: "clry4s*as so"or'so FrOFN3eO FT Or LOT 68LYGWOF.ORGENSEN RD ANDS150 FT OF N36OFT OF LOT 59MISAG)04WUMM Block No.
Project Name: Jorgensen
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replaced all electrical outlets.
rCONSTRUCTION INFORMATION:
Additional work to b4p nerformed under this permit—check all apply:
0HVAC 13 Gas Tank F]Gas Piping ri Shutters FlWinclows/Doors
ZElectric F1 Plumbing OSprinklers F—I Generator Roof Roof pitch
Total Sq. Ft of Construction: SQ. Ft.of First Floor:
Cost of Construction:$ 1,500-00 Utilities:0 Sewer Fleptic Building Height:
OWNER/LESSEE: CONTRACTOR:
N am e J J Rochford JR) Name: Todd Toussaint
Address:5475 NW Saint James DR#229 Company: Toussaint Electric
City.. Fort Pierce State: FL Address: 420 1 st Street Suite 6
Zip Code: 34983 Fa*x:N/A City: Vero Beach - State:FIL
Phone No.NIA Zip Code: 32962 Fax: 772-226-5770
E-Mail:NIA Phone No. 772-925-1223
Fill in fee simple Title Holder on next page(if different E-Mail: toussaintelect�c@gmaii.com
from the Owner listed above) State or County License: EC1 3005072
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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Jan 1U10. 12:34p Toussaint Electric
772-770'0808 p.2
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not 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:
City: Cltv�
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the workand 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 ail 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 a rid posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
ommencing work or recording your Notice of Commencement.
Signature of Owner/Lessee/Con.tractor as Agent for Owner Sig6ature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
-add, -roomu4
Name of person aking statement Name of person making statement
Personally Known ��Olk Produced identification Personally Known V"_ OR Produced Identification
Type of Identification Type of identification
Produced Produced
i -State of Florida) ature of Notary Publli-Alztate of Florida
(Signature of Notary Pubb
Commission No. C��#6015= Co m mission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW �REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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