HomeMy WebLinkAboutBUILDING PERMIT APPLICATION0
ALL APPLICABLE INFO MUST BE COMPLETED FOR
Date: 2 t -.
Buildinj
LICATION TO BE ACCEPTED
Permit Number: E(AI
11
SCANNED RECEIVEp—`—
BY
0�!Wf Aff lkation APR 2 6 2
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
D10
ST, Lucie Co
unty, Permitting
Residential YES
PERMIT APPLICATION FOR: To Select from
dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: 'I"
Y
Address: 5105 Palmetto Dr, Fort Pierce, FI 34982 I ft 6 Q/ 1 9" i )
Legal Description: INDIAN RIVER ESTATES - UNIT 5 BLK 5 - LOTS 32 AND 33
Property Tax ID #: 3402-606-0029-000-2 Lot No. 32 & 33
Site Plan Name: Block No.
Project Name: JOURNET RESIDENCE
Setbacks Fro Bac 67 Ri ht Side��. 3Left Sidg; �3'
XIETAI1LED DES' R'IPTION �O°F WORK
New single family constructionkodrm, 3 bath,,2 car garage
3
CONSTRIJCTlO.NINFORIVIASTIO'N ,
Additionalwork to be r) rformed under this permit -check all that app y:
�HVAC LJ Gas Tank Gas Piping �_ Shutters a Windows/Doors
❑✓_ Electric 0 Plumbing pi
Total Sq. Ft of Construction: 2876 t."'�u —
Cost of Construction: $ ,i09a M- xL
?rs 1:1 Generator W1 Roof Roof pitch
Sq. Ft. of First Floor: 2876
Utilities:Sewer Septic Building Height:
OWNER/LESSEE:
i
CONTRACTOR:
Name A"%%o`
Address:-,non M&r AA
City: Pose VHF -c_I° State:IFL
Name: 77�c-Fm'1 V%eak
Company: ASSOCIAtED HOMES INC.
Address: Jo
City: -_iax "4�- State: FL
Zip Code: 3LJga r� Fax:
Phone No. 9 �Sq- (Aa - q16 a
Zip Code: 34984 Fax: 772-340-0039
E-Mail:�(a ! .& \a;
Fill in fee simple Title Holder on next page ( if different
Phone No. 772-343-0302
E-Mail: JEREMY@ASSOCIATEDHOMES.NET
from the Owner listed above)
State or County License: CBC1255892
If value of construction is $2500 or more, a RECORDED
of Commencement is required.
6W?
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENG VEER: _ Not Applicable
Name:�Mm'N r�uS�CSI —_ Y,x
MORTGAGE COMPA Y:
Name:
_ Not Applicable
Addr ss: p ���, _ %\J I
City: vex-- tee; State: FL
Address:
City:
State: FL
Zip: 34984 Phone 772-285-0572
Zip: Phone:
-
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
zNot Applicable
Name:
Name:
Address:
Address:
City:
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 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 frLm 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
befor the first inspection. you intend to obtain financing, consult with lender or an attorney before
co me Qft work or rec rdi g vour Notice of Commencement.
Signature of Owner/ Les ee/Con ractor as Agent for Owner
Signat re Contr r/License Holder
STATE OF FLO�lp�4
COUNTY OF , ,��
STATE OF FLORIna
COUNTY OF JiLXL�
The forgoing instru ent was acknowledged before me
this J& day of 20�' by
The forgoing instru ent was acknowledge before me
this day of 20 � by
Name of person making statement
Name of perseln aking statement
Personally Known OR Produced Identification
Personally Known ��OR Produced Identification
Type of Identification
Produced 'y/rS:C�SV_
Type of Identification
Produced
(Signature of Notary Public- Stat
�►�`" Notary Public
No. o S�alA�borah
conwAssion
op Expires 00111/2021
State of
M Slerensm
GG 1
re of Notary Public- Sta pUL9 i
:1ona r Public Stara atCommission
sion No. !I ��h M Stevens
my Cwwftsion GG 127
Expires 08111/2021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17