HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1
APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,\ )
te: Permit Number: h5t\&�5/
Building Permit Application SCANNED
ing and Development Services. Ludo �����!
ng and Code Regulation Division V
Virginia Avenue, Fort Pierce FL 34982
e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
RERM'IT APPLICATION FOR: To Select'from dropbox, click arrow at the end of line
I;I
PRO,P®,.SED�14M'P�RO,�VE�M�ENT�L®C�AT�I;®N� �jr �4.;� a
Adldress: 4680 Jorgensen Road; Fort Pierce, FL 34981
Legal Description; 5 36 40 W 41,0 FT OF S 165 FT OF NW 114 OF NE 1/4 OF NE 1/4-LESS W25 FT RD WM -
(1.�46 AC) (OR 3298-2788)
Property Tax ID #: -3dfO57— 112— 00�5-0i�0^I Lot No.
Site Plan Name: IMg t GeV Block No.
Pr I�ectName: MWIVes
d
Se backs Front Zd Back: J 0 Right Side: Left Side:
DtfTAIFL@D1�®E-�S`CR+.IP�TI®NiK®tF
,..
Install enclosed 30x4lx12 detached accessory structure on footers/concrete
**N ; ELECTRICITY**NO PLUMBING"
CONSTRUCTION IIN�F®R�MATIO,N
w
Add.i.tional work o flasTank
orme under is permit — check a apply:
�HVAC Gas Piping _ Shutters Q Windows/Doors
it Electric Plumbing []SprinklersEl-Generator 171 Roof 3/12 Roof pitch
Tota li, S . Ft of Construction: 1200 S�Ftj of First Floor: 1200
EC0:tilof Construction: $ : Itii 9Ob' Utilities: LJ Sewer Septic Building Height: 12
O�WNERs/LEStSEE t
Naml (SHAKE MW-VE Y
Addr ss: L468o T0RCj6A(sEA1 R0,4b
City: FORT PIERCE State: FL
C®,NTRAGT�'R' ::-
Name: j AM E 5 PLAYER
Company: Carports Anywhere
Address: Ah%SO (0REj4NSEN IQ046
Zip Code: 3+981 Fax:
Phone No. [�?22 519 — 0281
E-Mllil: 6h-'ne.4DM12M1P1jb— ewn
City: FORT PI ERCE State: FL
Zip Code: 32091 Fax: (352) 468-1113
Phone No. (352) 468-1116
E-Mail: lbpermitsfl@gmail.com
State or County License: CBC1251995
Fill i j,1fee
from
ICI
simple Title Holder on next page (if different
he Owner listed above)
"
IT value or construction is �iZWU or more, a RECORDED Notice of Commencement is required.
Ail APPLICAB - .NF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED . o d- - 0 SS)
Date: / Permit N be : .,
LUXANC
Building .Permit Applicati n AUG 201�
PlllnningandDevelopment Services Pei mittijlg Department
e4"ilding and Code Regulation Division
2300 Virginia Avenue,I'Fort Pierce FL 34982 St., Lucie Co u it ty r FL
P it one: (772) 462-1553 Fax: (772p462-1578 Commercial e51 entia
PE MIT APPLICATION FOR:, To Select from dropbox, click arrow at the end of line
PROPOSED,IMPROVEMENTLOCATION:
Add�ress: 4680 rgensen Road; Fort Pierce; FL'34981. .
Leg �Il Description: 36 40 W 41.0:FT-OF. S 165 FT OF NW 1,/4 OF NE 1/4.OF. NE 1./4-LESS W25 FT RD W/W
(1.416 AC) (OR 3298-2 8)
Prolerty Tax ID #: "' �,2+ ODos--o00-i Lot No.
Site l Ian Name:. M%41 NJ Block No.
Proj Ict Name: iMu��e
I i Setbiiacks Front VO Ba 30 Right Side: Left Side:
fl.
DETAILED DESCRIPTION-OF,1N )RR
Instill enclosed 30x41x12 detached`qccessory si`ucture on footers/concrete
I
CONSTRUCTION .INFORMATION:
Addiponal work o e performed un er is ermit— ec all apply:
HVAC Gas Tank as Piping, _.Shutters Q Windows/Doors
Electric . Plumbing Sprinklers, Generator z Roof 3/12 Roof pitch
Total q. Ft of Construction: 1200 S Ft. of First Floor: 1200
Cost of Construction: $ 5495.00 Utilities: _Sewer 17]Septic Building Height: 12
OWNER/LESSEE:. F:::`
CONT CTOR:
_
Nam IIII� (SHgAIE 'M01-VE
Addr'ss:680 TORC�E S�� ROAD
City: `; 'ORT.P/ERC� State: FL
Name: AM.E S . PLAYER
Com an rp�t,Anywhere
Compal
Address: (1GR
Zip C, ode: 3+98.1.. fax:
Phone No. ??2 19 — 028 /
City: FORT P RCE State: FL
Zip Code: 32091 Fax: (352) 468-1113
Phone No. (352) 468- 116
E-MaIII:
shaneg ml*plb; com
fee simple Title Holder on next page (if different
he Owner listed above)
Fill in
from
�-Mail: Jbpermitsfl@gm!�,com
State or County License: CBC1251995
If valulof construction is 52500 or more, a RECORDED Notice of Commencement is required.
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r
SUPPLEMENTAL:CONSTRI)CTION LIENLAW:INFORMATION:
DESIGNER/ENGINEER:
1�6me:BECKraL EN4 Ai'+<ER/Al(
l�d dress:.605 West New York Avenue '
_ Not Applicable
AN07'esnalq
MORTGAGE COMPANY: _ Not Applicabie
Name:
Address:
City: State:
Zip: Phone:
Oyty: DEtgKO State.: F1_
Z�p; 32720. Phone
1
FtE SIMPLE TITLE HOLDER:
Dame:
Alddress:
_ Not Applicable
BONDING COMPANY: Not Applicable .
Name.:
Address:
.City:
Cty;
Z�Phone:
I
Zip: Phone:
O1#NER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to. do the work and installation as indicated.
I c Irtify that no work or installation has commenced prior to the issuance of a permit.
St. Lie Countyy makes'no representation that -is granting'a permit will authorize the permit holder to build the subject structure
whi" h is in contlict 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 clinsideration .of the granting of this requested permit, I do hereby agree that I will, in.all respects, perform the work
in a Icordance 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
hJ
W/ RNING 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
corr mencinE worll recordirie vourr-Notice of Commencement.
Sid" atu f Owner/Lessee/Contractor as Agent for Owner
SignatuhAf Contractor/License Holder
STRIATE OF FLORIDA
CC UNTY OF BRq-p F70A p
STATE OF FLORIDA'
COUNTY OF BR�bf'QRA
Th for oing instrument was acknowledged before me
thi I i- day of A PIR t L 20 IS by'
The for oing instrument was acknowledged before me
this day of 20l S APAI L, .20 �8 by
(J^l P_ArEg
c1AA4r:s PLAyl:R
IName of person making statement
Personally Known_ oR Produced Identification
Name of person making statement
Personally Known'. ( OR. Produced Identification
Tyge of Identification
Type of Identification.
Pr duced
Produced
n�7q
Y&tA�
(Si " a t a hh c- a ee F on . .)
otafy.F-ub c Sta a oforida.
(Signature of Nota i J
?o ^
Maria R BurginNotary
Co Gommiselnn FF Q��775 ( al)
Public �} Fbrida `I
Commission No. ria R Butfi
Expires o8/2512019
4 c M y Commission FF 912775-- ,
or n Expires o8125/2019
R VIEWS- �
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
�I
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
.RECEIVED
DATE
COMPLETED
Rev. 812/17