HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 911V` ��1 1 Permit Number:
Building Permit ApplicationLM
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION:
Address: 5117 Buchanan Drive., Fort Pierce, FL 34982
Legal Description: Indian River Estates Unit 1 Block 1 Lots 25 and N 1/2 of Lot 25 (Map 34/02S) (OR 1644-224)
Property Tax ID#: 3402-602-0025-000-2 Lot No.25/26
Site Plan Name: Block No. 1
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Demo and remove all existing windows, (3) doors including Front, Garage, and Back Door, and (1)
sliding glass door. Supply & Install all new windows to house, (3) new doors, and (1) sliding glass door
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC E]Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing O Sprinklers Generator •Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ a a 7 Utilities: _Sewer F]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Michael W Martin Name: John Jacobs
Address:5117 Buchanan Dr. Company: John Jacobs Construction Inc.
City: Fort Pierce State:FL Address: 4701 Oleander Ave.
Zip Code: 34982 Fax: City: Fort Pierce State:FL
Phone No. Zip Code: 34982 Fax: 772-466-6491
E-Mail: Phone No. 772-882-8334
Fill in fee simple Title Holder on next page(if different E-Mail: jmjacobs4701@gmail.com
from the Owner listed above) State or County License: CBC060421 /19245
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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:
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 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.
k— \nd L—N
Signature of 0ZDA
/Lessee/C tractor as gent for Owner Signature o ontractor/Li se Holder
STATE OF FL STATE OF LORIna
UCONTYI � L LA_c; 2, COUNTY OF L u, i
The forgoing instrument was acknowledged before me The forq�ng instrument was acknowledged before me
this I Ith day of Seipfer,Igor 20Jg by this I I day of a pier•bor 20 R by
�O r\ _RCo bs 7:5o 6S
Name of person making statement Name of person making statement
Personally Known�-OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature Aotary Public-State AFIorida) (Signature of NotA Public-State of F ida)
Commission No.Q.- IC549TO00 1
a o mi ion No.����oS4O +�f� ea4}lOtaypoplicgs�ofJidiak
�a► Notary Public State of londa yP � ���y
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Casey Binkley ;� �
VTJ My Commission GG 9 8806 so
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REVIEWS FRONT Z TYPYRTrSff P N VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17