HomeMy WebLinkAboutBuilding Permit ApplicationDocuSign Envelope ID: CD40077943846-4715-9610-F1 B58F323C74
All APPLICABLE INFO MUST BE COMPLETED FOR APPUCATiON TO BE ACCEPTED
Date:
Permit Number.
DI j
Building Permit Application
Planning and Development Services
Building and Code Regulation DivW n Commercial Residential x
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:constructIQn of Single family residence
k ._w _7 .7
Address: 0 PALMETTO DRIVE
Property Tax ID #. 3402-606-0073-000-5
Site Plan Name: INDIAN RIVER ESTATES
Project Name: JAC013SON RESIDENCE
CONSTRUCTION OF NEW SINGLE FAMILY RESIDENCE
New Electrical Meter X Second Electrical Meter
Lot No. 5&6
Block No. 24
Additional work to be performed under this permit –check all that apply:
L Mechanical ^ Gas Tank — Gas Piping _ Shutters Windows/Doors Pond
',Electric Plumbing r Sprinklers Generator Roof 12 Pitch
Total Sq. Ft of Construction; 3592
Cost of Construction: $ 187,500
Sq. Ft. of First f=loor: 2551
Utilities: I- Sewer ' _ Septic Building Height:
NamePETER & BRIDGET JACOBSON
Address: 140 SW EULER AVE.
City: PORT ST. LUCIE State: _
Zip Code: 34953 Fax:
Phone No. 772-924-6977
E -Mail: PALLIEBRIE@ YAHOO.COM
Fig in fee simple Title Haider on next page ( d different
from the Owner listed above)
Name -RYAN DAVIS
Company: SYNERGY HOMES, LLC
Address:3950 RCA BLVD., SUITE 5000
City. PALM BEACH GARDENS State: FL
Zip Code: 33410 Fax:
Phone N0561-315-3317
E -Ma it RYAN @ SYNE ROYHOMESF L. COM
State or County License CBC1 254289
It value of construction is 250D or more, a RECORDED Notice of Comnwricernent is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencernent is required.
DocuSign Envelope ID: CD4D0779-0846-4715-8610-F1B58F323C74
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_ _
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: K Ez
Name:ToawK
Address: 1824 R�o LAW
Address: 5kWSE FE4EML NK Ht Y
City: Pw sw mus
State: FL
City: 51-M
State: FL
Zip: asun Phonese+
Zip: Phone: m-4w4,n
FEE SIMPLE TITLE HOLDER: M
Not Applicable
BONDING COMPANY.• r
Not Applicable
Name:
Name:
Address:
i 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.
SL Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in corrfiict 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, perforin the work
in accordance with the approved plans, the Florida Building Codes and SL 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 fallure 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
?wnerr/ Lessee/Contractor as Agent for Owner 1Signoture of Contractor/License Holder
STATE OF FLORIDA /� STATE OF FLO"A
COUNTY OF �iRLf 1� �% ( i COUNTY OF t- u CP iii .ice
Sworn to (or affirmed) and y<Ipscribed before meof S to (or affirmed) and subscribed before me of
_ P ical Presenceor ,/N Online Notarizatic n Physical Presence or _ Online Notarization
this day of ) n lT--. 2020 by this _day of 2020 by
�iGPGPi �CLCUUJU�� yGn NUIS
Name of pers6n making statement Name of person making statement.
Personally Known --k— OR Produced Identification Personally Known K OR Produced Identification
Type of Identification T of Identification
P wed Pr ce
ature of Notary Pu State 4 of Notary P' �� A rw
0. ANNE L. JOHNS -_ OEC 'F. L JOHNSON
Commission No. 00MMISSION fI GG25 mission No. i M�2vlba IIA-G0251N45
-� FXPIRES: July 17,20 1 PR%R F5 Jul, 17.2021
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