HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
L, Co9- 1 c. C;� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: ( i r-\ 6 0
s1.
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 1 '- %1 - 6. & t 3 Lot No._
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Windows/Doors Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1 q
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameC-ln,y'i5 ='_ ►L)c;_, `-i ��,-t lt�X;z�
Name: Jeremiah K. Johnson
Address: `. L R
Company: JBR Exteriors, Inc.
City: 'J L�i� v G-_ State: EL
Zip Code: 13gC" �j Fax:
Phone No. E-
Mail:
Address: 1201 SW Biltmore Street
City: Port St Lucie State: FL
Zip Code: 34983 Fax:
Phone No 772-873-0600
Fill in fee simple Title Holder on next page (if different i
from the Owner listed above)
E-Mail info@jbrexteriors.com
State or County License FLCBC#1260687
•• - __ — 1. .... o A�VV VI ,,VFW, d ICC\.VF%UCU IVOilce oT Lommencement Is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State,
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: _Not Applicable
Name:
Address:
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.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any. applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 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
with lender or an attornev before commencine work or recording vni,r NotirP of CnmmPnrPmPnt
Signatbre of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
,
COUNTY OF ' ,.1-_
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of )Lira; 20Z_? by
Name of person making statement.
Personally Known A; OR Produced Identification
Type of Identification Produced
(Sign&ure of NotaK Public- State of F
._r•c� Notary Public State of Florida
`F Stephanie Faye Douthitt
Commission No. (Se )s < My Commission
YOFl
HH 166709
Exp, 8/19/2025
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