HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MU E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' t Permit Number:
Building Permit Application [-RECIEIVED
Planning and Development Services JUL 0 2020
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST..L cie CZ
y, Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resi t4
PERMIT APPLICATION FOR: Window/door
RROPC►$ED [IVIPROUEMENT LOCATION::,
Address: 405 Gregory St, Ft Pierce, FI 34982
Legal Description: Indian River Estates Unit-04- BLK 37 Lot 17(Map 34/02N)(OR 445-1409:817-428:2780-1033)
Property Tax ID#: 3402-605-0107-000-0 Lot No.17
Site Plan Name: Block No. 37
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Installing twelve windows in eleven openings of the home. �,`pAc-t—
CONSTRUCTIQN INFORMATION
Additional work to be nertormed under this permit—check all ral
0HVAC Gas Tank Gas Piping utters Window /Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Ga
Cost of Construction:$ �. CyG Utilities: _Sewer[]Septic Building Height:
.OWNER/LESSEE CONTRACTOR:
Name Rebecca&Jeffrey Jacobs Name: _-To h n 1 F f�A nC 9 SCo
Address:405 Gregory St Company: Sak^ D iv P r n n e Q-C2 C o n 9
City: Ft Pierce State:R10 Address: _t-/712. SG+nSy-r 8
Zip Code: 34982 Fax: City: F'T P,,erc�t State: FeA
Phone No. �'71, 9-7( '�'.L b3 Zip Code: 3C! 9'82 Fax: ?72 c-(6S 72 4-
E-Mail: Phone No. 7 I2 2 iS 3 ?K�
Fill in fee simple Title Holder on next page(if different E-Mail: :1 o A P% D 4-0 1 3( A T T, ibQ?
from the Owner listed above) State or County License:_Cd?C' 13 1-7 2 If
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CflN5TRUCT1flN LIEN LAW INFORIUlAT1flN
,, ,
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: 5 Name:
Address: 2 Address:
City: Ft Pierce 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 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
commencing rk or recording our tice of Commencement.
Signat of_OiWher/Lessee/C ctor as gent for Owner Signature Contractor/License Hold
STATE OF FLORIDA ST OF FLORIDA
COUNTY OF St Lucie COUNTY OF St Lucie
ThePrgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,&L day of Jci 1.1 2021_ by this,2hi day of Sln 1� 202v by
L5 W1 Q i I!Y xo ,d J..- o; �'1�atn-moo v
Name of person making statement Name of person 3,aking statement
Personally Known_!�OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
I/
(Signature of NM_ 5_�
NOT Y ����) (Signature of Notar ic- Id3.1 )
NOTARY PUBLIC
Commission NoSTATE OF FL I Commission No. sSTATE OF FLq"
Comm*GG94 237 a Comm#GG945237
"acE ASPR Expires 1/15/2024 �e Expires 1/15/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17