HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST 7BEE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4P. /y . SCANNED Permit Number:
BY
gftwl _ ._ St.Lu�ieCounty RECEIVE®
Building Permit Appli ation JUN 12 2019
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce n 34982 Permitting Department
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial esF&rhWI Y'e County, FL
PERMIT TYPE: Fence
PROPOSED IMPROVEMENT LOCATION:
Address: 4780 Jorgensen Road, Fort Pierce, FLU /34982
Property Tax ID #: JV0 R -•�O�' 0) 7• k/ - Q 0, 7 Lot No.
Site Plan Name: )1y� \ Block No.
Project Name: W r 1 r T e % 4-,A
°DETAILED DESCRIPTION OF WORK:
Pool Fence
Additional work to be performed under this permit - check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing fnJ _ Sprinklers _ Generator _ Roof Pitch
Total:5q. Ft of Construction: l Sq. Ft. of First Floor:
Cost of Construction:$ 1,000.00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: -
NameBrandi Pearson
Name:
Address:4780 Jorgensen Road
Company:
City: Fort Pierce State: _
Zip Code: 34981 Fax:
Phone No.772-528-2392
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: brandi.pearson85@gmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: d
City:
Zip:_
FEE SIMPLE TITLE HOLDER:
State:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name'
Address:
City: City
Zip: Phone: I Zip:
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 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
PO ED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
W YOUR LENDER ORAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Z/ vj� I
Sign ure of Owner/ Lessee/Contractor as Agent for Owner
Si ature of Contractor/License Holder
STATE OF FLORIDA r,([ , -
STAT OF FLORIDA
COUNTYOF 7 ��,
E
COLIN OF
The forgoing instruiu t was ackno ledged before me
The forgoin instrument was acknowledged before me
this � day of l� 26,&-by
0
this _ day f . 20_ by
ame of person making atement.
Name of person ma 'ng statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi ti
Type of Identification
Produced ` C
Produced
(Signature of N;btf ry Public- State of Flori )
(Signature of Notary Public- State of F ida )
Commission No. :'y�tl:,"•:" AUDREy�jUMPHREY
Commission No. ( al)
COMMI$�I #GG300817
EXPIRES: March 8, 2023
a`,Zb:i;g.•
nded"rhm ry
eW
REVIEWSSUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. yi/ly