HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
r) IJo Ls(gjc�LS
° Building Application
Permit A lication
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Carl & Adeline Jorgensen
PROPOSED IMPROVEMENT LOCATION: Indian River Estates
Address:
Property Tax ID g:
Site Plan Name:
Project Name: Indian
river estates -Jorgensen
3402-608-0157-000-4
Jorgensen Residence
DETAILED DESCRIPTION OF WORK:
3,2,2 Single family homes
New Electrical Meter yes Second Electrical Meter no
CONSTRUCTION INFORMATION:
Lot No. 13
Block No. 43
Additional work to be performed under this permit -check all that apply:
XMechanical _Gas Tank _Gas Piping _Shutters X Windows/Doors _Pond
X Electric X Plumbing _Sprinklers _Generator x Roof 6/12 Pitch
Total Sq. Ft of Construction: 1893 Sq. Ft. of First Floor: 1893
most -of Construction-$-Z29I — �00000000�tHitiesNewer X-Septic uilding-Height:00000000
!OWNER/LESSEE:
CONTRACTOR:
Name Carl & Adeline Jorgensen
Name: Mark Montalto
Address: 23 Austin Dr.
company: PSL Properties Inc.
City: Edgewater State: MD
Zip Code: 21037 Fax: N/A
Phone No. 410-279-7160
Address: 201 SW PSI Blvd,
city: PSL State: Flo
00000000
Zip Code: 34984 Fax: N/A
Phone No 772-336-0050
E-Mail: kkerscn@att.net
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mall pslprop1 @gmail.com
State or County License CBC1263072
If value of construction Is 2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLE►VIENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY: X Not Applicable
Name:
Address;
City: State: _
Zip; Phone:
DESIGNER/ENGINEER: _ Not Applicable
Name: Paul Welch Inc.
Addre I more t.
City: 11 State: FI.
zip: 34984 Phone 772-785-9888
FEE SIMPLE TITLE HOLDER: X Not Applicable
Address:
City:
zip:
BONDING COMPANY:
Name:
Address:
City:
Zip; Phone:
x Not Applicable
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 con lli with any
Withpyolur Home Home owners
Assoc atlori and rules, bylaws
daed for any restrictions which maor
alprohibit such
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of consult
Lucie County and potted on the jobsite before the first inspection. if you intend to obtain financing,
with lender or a c rr;ey befonwCommencing work or recording ylaur Notice of CC encIpment,
as Agent for Owner
STATE OF FLORIDACSTATE OF FLORIDAn, � 11U�
COUNTY OF, SSA- i t 1Q4 e COUNTY OF �}I
Sw,Qrn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Presence or_Online NotarizationPhysical Presence or_Online Notarization
7 2020 by this,2,Q day of 1 _ � 2021 by
this cday of Q
Name of person making statement. Name of person making statement.
Personally Known _ _ OR Produced Identification Personally Known — OR Produced Identification
_,, Type of Identification
Commission No.
REVIEWS FRONT
COUNTERNO
(Signature of
Commission
REVIEW I SREVREWOR I REVI W VREVEWON
SEA TURTLE MANGROVE
REVIEW REVIEW