HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit`Number:
-��) L�3
RECEIVED
91r. LUC E -
o SEP 10. 7WO
S. V Building Permit Application PerSt.Lucie
count,St.Lucle Counr�•
Planning and Development Services
Building and Code Regulation Division -,...Commercial Residential XXX
2300 Virginia Avenue,Fort Pierce FL 34982 !�
Phone: (772)462-1553 Fax:(772)462-1578 airy ,
PERMIT APPLICATION FOR: Remove existing roof and replace wit
PROPOSED IMPROVEMENT LOCATION:
Address: 4680 JORGENSEN RD
Property Tax ID#: 3405-112-0005-000-1 Lot No.
Site Plan Name: Mulvey Roof Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:.
Remove existing roof and replace wiiir5V-er
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers —Generator I Roof Pitch
Total Sq. Ft of Construction: 2145 Sq. Ft. of First Floor: 2145
Cost of Construction:$ /Z •• • Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Shane K. Mulvey Name:John G Cannon
Address:4680 Jorgensen Rd Company:John G Cannon
City: Fort Pierce .State:— Address:7901 Citrus Pk Blvd
Zip Code: 34982 Fax: City: Fort Pierce State:FL
Phone No.772-519-0281 Zip Code: 34951 Fax:
E-Mail: Phone N0772-4468-0202
Fill in fee simple Title Holder on next page(if.different E-Mail
from the Owner listed above) State or County LicenseCRC29914
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW]NFORMATION:
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 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 1 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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.
alo"tl JA6
Sign '46f Owner/Ilessee/Cordractor as Agent for Owner tur ac Lic a Holder
STATE OF FLORIDA I ST OF FLORI
COUNTY OF JT. Lu c,I� UNTY OF Ta U) , -
S orn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical PresWce or Online Notarization Physical Pre ence o Online Notarization
this 1 nay of t"VA0L1S_F_ ,2020 by this V day of 2020 by
— shoux MANN
Name of person making stateHent. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produ ed � Produced
(Signature of Nota (Signat
i MUiHPIDMUClQ OW 19 g ;SpPY PVA E ! N I E L S E N
State of Florida-Notary P�,b lic
Commission No. :�: �'� Commis 6 Comnnissirn !t GG 207d$ al
2022 a M Commission Expires
.. pl.�BOIIdCd7kuNatXyPWAUndXWf 0 �.�forc o? Y
�` " June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20
l