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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01110120.17 Permit Number: 1���� �4�5
RECEIV7D FEB 23 2017
Building Permit Application
Planning and Deveiopmentservices
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: Modular home
R OPOS D 0�E 7 N UEM .Ifi�:CAT
Address: 4442 Edwards Rd,Ft_Pierce, FL 34981
Legal Description: 30 35 40 FROM INT NLY RIW EDWARDS RD AND WLY R1W ROGERS RD RU N 00 29 26 E 335.06 FT,TH S 88 23 E 327.1 FT,
TH N 8812 21 E 524.86 FT,TH N 0029 26 w 328 FT TO 1`08(3.94 AG)(OR 224-960:267-1875:303-9;2211-2847:2531-1849..2211 2647:3693-648:3693-1025)
Property Tax ID 11: 2430-113-0001-000-1 Lot No.
Site Plan Name: Block No.
Project Name: HARRIS
Setbacks Front Back: Right Side: Left Side:
RETAILI; Q. Vrf_
NEW ON-FRAME MODULAR HOME WITH METAL CARPORT, SKIRTING,AND STAIRS
_
R TIQl�.111IF RMA D -
Adclitional work to e e orme un er is pert itt—(-neck a that apply:
ZHVAC E]Gas Tank ❑Gas Piping FI Shutters O Windows/Doors
Electric Z Plumbing Sprinklers I Generator E]Roof Roof pitch
Total Sq.Ft of Construction: 1494 S .Ft. of First Floor: 1494
Cost of Construction:$ 150.,000 Utilities: _Sewer septic Building Height: 13
.. :. : :E ...,-:...:,:........... .. ... :..:. ... TRACT - -
Name LORRAINE HARRIS Name: JOHN GRAHAM
Address:4442 EDWARDS RD Company: JTG CONSTRUCTION LLC
City: FT PIERCE State:FL Address: 109 CEDAR OAK TRIAL
Zip Code: 34981 Fax: City: LONGWOOD State:FL
Phone No.772-464-5146 Zip Code: 32750 Fax:
E-Mail..JEANETTEHMM(c_bHOTMAIL.COM Phone No. 352-434-9706
Fill in fee simple Title Holder on next page(if different E-MaB: ]tg rock@yahoo.com
from the Owner listed above) State or County License: CRC1330908
If value of construction 1s$2500 nr more,a RECORDED Notice of Commencement is required.
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DESIGNERIENGINEER: x Not Applicable (MORTGAGE COMPANY. x Nat pplicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
{
FEE SIMPLE TITLE HOLDER: x x
Not Applicable BONDING COMPANY: Not Applicable 1
Name., Name:
Address: Address: `
City: City:
Zip: Phone: Zip: Phone:
t
l 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 permitwill authorize the permit holder to build the subject structure
which is in conflictwith 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, j
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory use 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. r
s
Signatu a of Owner/Lessde/Contractor as Agent for Owner Sign Con#racto cense-11 bIder
STATE OF FLOR A TE OF FLORIDA
COUNTY OF � �. ._ COUNTY OF S „-'A_Z .
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 JAy this-1�day a 20 J�by
-17
a of person acknowledging} (Name of person acknowledgin
Signature of Notary Public-State of Florida) (Signature o tary Public-State of Florida} /
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced ♦i(� �,
F� 2� DIANA E. BO � �R7.`� {
Commission No. ,oti�ar Pb� aI} KCommis on o. �,a��
:. o; Notary Public-State of Florida ;o�'A � al} MICHAEL LO
* Commis,inn #FF 02155 'r .°E Notary Public-Stat f Florida
' My Comm :xpires Jun 14,2019 � c�c ommiss on# 3924
Revised 07/15/2014 Selig Bondrd— ,:gh NationalfbaryAtw. My Comm.Expires Ma 14,2017
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