HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:_cal\— os 61
4 r � 7 RECEP"D NOV 2 8 2016
0
Building Permit Application
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 Residential xx
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED-IkPROVEM ENTI'LOCATION`:
Address: 5220 Dunn Road, Fort Pierce, FL 34981
Legal Description: Dunn Road Estates S/D (PB 46-1) Lot 5 (2.43 ac) (Or 3571-2625)
Property Tax ID#: 3403-702-0006-000-3 Lot No.5
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRfPTION OF WORK:
Fencing, Woven wire 4' on the North side are rear of property. Front fence will be 4' horse fencing.
CO N=STR:U�CTIO�N,�I N,FO RMATIO N.
Additional work to be nerformed under tispermit—check all that appy:
❑HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 500.00 Utilities:Sewer Septic Building Height:
OWN E R/LESSE.E: CONTRACTOR:.
Name A Pink Jelly Bean Inc Name: Julio Batista
Address: 1082 SW Bayshore Blvd Company: JC&Sons Builders Inc
City: Port St Lucie State:FL Address: PO Box 7247
Zip Code: 34983 Fax:772-879-2070 City: Port St Lucie State:FL
Phone No.772-618-5244 Zip Code: 34985 Fax: 772-879-2070
E-Mail:a@c2lsilva.com Phone No. 772-343-0221
Fill in fee simple Title Holder on next page(if different E-Mail: a@c2lsilva.com
from the Owner listed above) State or County License: FL#0040647
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LI°EN'LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
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 our Notice of Commencement.
s
I ature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
CO U NTY O F St Lucie COUNTY OF-St Lucie
The for oing instrument was ackn wledged before me The forgoing instrument was a��knowledged before me
this ay of20 Eby thiday of !0 20 b by
Janet Rossignol 1 Janet Rossignol
(Name of person acknowledging) (Name of person acknowledging)
(S, iggature of Notary Public-State of Florida) Versonally
t�ure of Notary Public-State of Florida
Personal) Known OR Produced Identification Known OR Produced Identification
Y
Type of Identification Pro ype of Identification Pro It irarl
;'wry;•,.,
JANET ROSSIGNOL .••4 .. '%
r: ,�o.• v�.: JANET,I�OSSIGNOL
Commission No. 11 o3zs7z ':+= Ml(`�I�IMISSION#FF03267 ommission No. FF032672 C3 fiih
'= MY SSION#FF032672
>'?� oa.• EXPIRES October 21,2017
o/tt„ %� ppOQ.• EXPIRES October 21,2017
(407)398-0153 FloridallotaryService.com
Revised 07/15/2014
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