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LL APPLICABLE!INFO MUST BE COMPLE FOR APPLICATION TO BE ACCEPTED
Date: 10, Permit Number:
; Z- -
Building Permit Application
Planning and Development Services �� ����
Building and Code Regulation Division J
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Building
PRQPOSED IMPROVEMENT"LOCATION:
7803 James Road
Address: i&-C ��s
Legal Description: Lakewood Park Unit 3 Block 17 Lot 21
Property Tax ID#: 1301-603-0021-000-1 Lot No. 21
Site Plan Name: Habitat for Humanity Lot 21 Block 17 Lakewood Park Unit 3 Block No. 17
Project Name: 7803 James
Setbacks Front 31.67 Back: 50.0 Right Side: 14.9611A-O�Left Side: >&M/14.96
DETAILED DESCRIPTI RK:
New construction of a 3 BR, 2 Bath CBS single family residence. Y" tnP,fy,(I ry /
'CON, TRUCTIOWNFORMATION:
Additional work to be nertormed under this permit—check all that apply:
WIHVAC Gas Tank []Gas Piping Shutters Q Windows/Doors
Z Electric ❑✓_Plum ' gi
Sprinklers El Generator W1 Roof 4�12 Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor: ( �� AD Lly
Cost of Construction:$ 150,000.00 Utilities:n Sewer,w]Septic Building Height: 8.0
°�IOWN;E-R/LESS EE:, CONTRACTOR:
Name St.Lucie Habitat for Humanity, Inc. Name: Joseph Gianna
Address: 702 South 6th Street Company: St. Lucie Habitat for Humanity, Inc.
City: Fort Pierce State:FL Address: 702 South 6th Street
Zip Code: 34950 Faux,772464-4377 City: Fort Pierce State:FL
Phone No.772464-1117 Zip Code: 34950 Fax: 772-464-4377
E-Mail:joseph@stluciehabitat.org Phone No. 772-464-1117
Fill in fee simple Title Holder on next page (if different E-Mail: Joseph@stluciehabitat.org
from the Owner listed above) State or County License: Florida Statute 489.103
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION MN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X Not Applicable
Name: 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 our Notice of Commencement.
i'a Z� '_;;'/�y / 1.
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natur Owner/Lessee/Contractor as Agent for Owner g ure of 9 tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SL COUNTY OF < I_L1(J�_
The forgoing inst ument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 aby this q day of ( L-LP.C" 20 by
(Name of pe on acknowledging) (Name of person acknowledging)
(Signature of Not y Public-State of Florida ) (Signature of No ary Public-State of Florida )
Personally Known )4N OR Produced Identification. I Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ° ' Commission No. AzUl Y``°c •: ER MM NISE MATSON
z....�. IN �1=i�SE MIATSON _: •._�: O �
`•`• ''e MY cOMM1SSION*FF072842 I'= MY COMMISSION rlFF072842
Revised 07/15/20 407)398-0153 FloridaNctarO&WCe.60hi (407)398-0153 PoridallotarySeivice.Com
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