HomeMy WebLinkAboutBuilding permit application/drawingALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: O�\9 00")
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 Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 3921 Shoreside Drive
Legal Description: Tarpon Flats Subdivision ( PB 69-27) lot 5 (or 3906-1990: 4103-1963)
Property Tax ID #: 1423-566-0008-000-7 Lot No. 5
Site Plan Name: Kevin & Susan Jansen Block No.
Project Name: Kevin & Susan Jansen
Setbacks Front Back: Right Side: Left Side:
Install power to one shutter with remote. Shutter by Folding Shutters . 0\VSao )_ � Do`)
ALKlltlonal WorK to De pertormeo unaer tnis permit— cnecK all mat apply:
❑HVAC IJ Gas Tank E]Gas Piping D Shutters Q Windows/Doors
13 Electric 0 Plumbing Sprinklers D Generator D Roof
Total Sq. Ft of Construction: S Ft. of First Floor: n
Cost of Construction: $ $550.00 Utilities:F Sewer USeptic Building Height:
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Name Kevin & Susan Jansen
Name: JAMES K WILLIAMS
Address:3921 Shoreside Drive
Company: ARLINGTON ELECTRIC
City: FORT PIERCE State: FIL
Zip Code: 34949 Fax:
Phone No, 408-610-0326
Address: 3251 SE DIXIE HWY
City: STUART State: FL
Zip Code: 34997 Fax: 772-287-2380
Phone No.772-287-1353
E-Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
E-Mail: gregg@arlingtonelectricinc . com
State or County License: EC 130077 67
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: u Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
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 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 work or recording your Notice of Commencement.
_ $mature of Owner/ Lessee/Agent
STATE OF FLORIDA MARTIN
COUNTY OF _
Th forgoing Instrumen$ was acknowledged before me
thi day of I— 20 Eby
JAMES -K WILLIAMS
(Name of person acknowledging)
(Signature o o ry Public- State of Florida )
�_Sairarrr
STATE OF FLORIDA
COUNTY OF MARTIN
The forgoing instrument was acknowledged before me
this Ro day of 20 J�J_ by
JAMES K WILLIAMS
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known X OR Produced Identification Personally Known X
Type of Identification Produced I Type of Identification F
Commission No, (Seal) I Commission No.
GREGG H ROBINSON
;2a �� �,
Revised a7/15/20i4 � Notary Public -State of Florida
vm
o`= Commission # HH 59076
OR Produced Identification
(Seal)
A ,AwAk-e
H ROBINSON
Notary vuouc - DLO — '--
Commission �, HH 59076
My Comm. Expires Noy 1. 2024
,_1 .6.,,—k KIAHMAI Notary Assn.
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