HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONL
ALL APPLICABLE INFO MUST BE COMPLETtu [-OR APPLICATION TO BE ACCEPTED
Date: �1 Permit Number: 005-'0- da
RECEIVED MAY 12 2017
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Building Permit Application cG-_C�51C)Ne6
Planning and Development Services SCABNNED
Building and Code Regulation Division io
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 St. WWAMI x Residential
PERMIT APPLICATION FOR:, To Select from dropbox, click arrow at the end of line cr r s,4 R ill
PROPOSED IMPROVEMENT LOCATION:
Address b C)r) k-I? S f i J •Q & Iy A 1 p
0(+S+ LiciQ Ll
Legal Description:
Property Tax ID#: n� J7iIr� ✓IJU00 I` ()(DO _ Lot No.
Site Plan Name: pOk P6,+ V /AL1c.r C_ Sf6A/ Block No.
Project Name: PGA POA VILLAGE SIGN
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: III
�fts-•f�ilG�-fion o� p�/+ Villct.�� PoPc sf9„
C_�
I CONSTRUCTION INFORMATION: III
czelt-Na
❑HVAC Li Gas Tank ❑Gas Piping UShutters
gElectric ❑ Plumbing ❑Sprinklers ❑ Generator
Total Sq. Ft of Construction: 31
ati `�7[' S Ft. of First Floor:
Cost of Construction: $ .WO • oUtilities. Sewer ❑Septic
Windows/Doors
❑ Roof ❑ Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name QnZ2(`na�Name:
JOHNJACOBS
Address: �. \ iJ `1�,� RaSer� c at
~`'C` JOHN JACOBS CONSTRUCTION, INC.
Company.
City: 'P c State: 1
Zip Code: `1 `\$ Fax:
Phone No. 5 L ` k -i 66- '&1 t 0
Address: 4701 OLEANDER AVENUE
City: FORT PIERCE State:FL
Zip Code: 34982 Fax: 772 466-6491
Phone No. 772 882-8334
E-Mail: av�eh� 1G R �� d�erv.Rr\k - C- rh
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: jmiacobs4701@gmaii.com
State or County License: C 6e, O&CP14Z1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
0 t &-4,0 6
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA i
COUNTY OF 5q - Lace,
The for oing instrument was acknowledged bggfore me
this day of In" 20 1 %by
1 _AN BI B
(Name of person acknowledging)
Personally Known
Type of Identification
Commission No.
Revised 07/15/2014
STATE OF FLORIDAS-T- (.Gca�CO[a Un
COUNTY OF
The forgoing instrument was acknowledged before me
this L day of /tIRY 20 by
d
(Name of person acknowledging)
(Signature of Notary Public- State of Florida /)
Personally Known ✓ OR Produced Identification
Type of Identification Produced
My COMMISSION # GG023715I
EXd1September 19, 2020 Commission No.
PATMCIA STEVENS
My COMMISSION # 0130237'
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
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INITIALS