HomeMy WebLinkAboutJordan Permit AppALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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) 462-1578 Commercial C1 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.PROPOSED IMPROVEMENT LOCATION.
Address: IoNoS- CXi-an,'bR, AP� 6yLi
Legal Description: JA -1 11 b -7 217 41—ml'i'VA
Property Tax ID 4: Lot No.
SitePlanName:— :1(6ayi Block No.
Project Name:
Setbacks Front_ Back:_ Right Side: —Left Side:
DETAILED
CONSTRUCTION INFORMATION:.
Additional worKtoDe oerrori:Fied uncler this permit — cneCK 311 ID.UL apply:
OHVAC F� Gas Tank E]Gas Piping Shutters Windows/Doors
11 Electric ElPlumbing oSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction's I Utilities: []Sewer 0 Septic Building Height:
OWNER/LESSEE:
Address: taic) 5.
City: lnevl) a State.
Zip Code: Fax:
Phone No. S3 — 1.
E-Mail:H-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name. -v I pi L
Company: 1--r Cti h -CO 177
Address:
State: FL -
City:
Zip Code:
Fax: -'n,? -z7
- 4 e
Phone No. -7 t:1 - -
an(c) (-Ca-)
State or County License: 15 1 � I . 1,
If value of construction is $2500 or more, a RECORDED Notice Of Commencement is required.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATI®N:
FRONT
DESIGN ER/ENGINEER:
N
Name: i-l�
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address: SIa 1+4lkelL kiv�r
MANGROVE
Address:
COUNTER
City:s - n+
Zip: `3�5� 3 Phone:
_
State: fG
3. &90-
City:
Zip: Phone:
State:
EEE SIMPLE TITLE HOLDER:Not
Name:
Address:
Applicable
BONDING COMPANY:
Name:
J—Not Applicable
Address:
City=
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County snakes 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 maycult in your playing twice for
improvements to yo roperty. A Notice of Commencement must be rec ed and posted on he jobste
before the first in ection. If you intend to obtain financing, consult wit ender or an aft ey before
commencingrk or recordi ar Notice of Commencement. - s
of
as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF zl&tN' COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ` ay of _ 0416t , 7Q _by this day of /9P: t 1 '20 k✓ by
(Name of person acknowledging) (Name of person acknowledging)
(Sig use of Notary Public- State of Florida )
Personally Known _ _ OR Produced Identification
Type of Identification Produced
Commission No.lr (t 318 )Tfj (Seaor.�A I ' GG32SIr
1ss+o� � y129 2p23
Revised 07/1.51201.4
(Sign re of Notary Public- State of Florida j
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. iX77i y Puarf� (S '1• rr-3.8!79
a COMM15510 R
�& e
Soles April 29, 2 cL3��
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS