HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4124117 Permit Number:
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 X
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION:
Address: 605 NW Winters Creek Road, Palm City, FL 34990
Legal Description: Harbour Ridge Plat #20 Lot #7 (or 862-2955, 2250-708, 2568-47, 3157-2633, 36)
Property Tax ID #: 4422-810-0017-000-7
Site Plan Name: Slaysky Residence
Project Name: Slaysky Residence
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK,
Right Side:
Left Side:
Lot No.
Block No.
Replace old windows to (7) windows with PGT series PW 720, (19) PGT SH700 and (5) PGT Serries
770 Sliding Glass Door white Frame Vinyl insulated impact Solar Ban 70 XL Low E glass.
CONSTRUCTION INFORMATION:
itiona wor to e e orme un er t is permit — c
ec a :1 :1
'Shutters
Gas Tank
❑Gas Piping
_
Y Windows Doors
�j f
Electric Plumbing
Sprinklers
[ Generator
Q Roof Roof pitch
Total Sq. Ft of Construction:
S. Ft. of First Floor:
Cost of Construction: $ 40,000
Utilities:
Sewer 11 Septic
Building Height:
OWNER/LESSEE:
Name Jay Slaysky
Address: 605 NW Winters Creek Road
City,: Palm City, State: FL
Zip Code: 34990 Fax:
Phone No. 248-891-7800
E -Mail: jay.slaysky@gmail.com
Fill in fee simple Title Halder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: Steve Rubin
Company: Rubin Custom Homes
Address: 4253 SW High Meadows Ave
City: Palm City State: FL
Zip Code: 34990 Fax: 866-480-7498
Phone No. 772-283-0553
E -Mail: receptionI.rubincustomhomes@gmaill.com
State or County License: CGC1518190
If value of construction is $2504 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL. CONSTRUCTfON LIEN LAIN
tion
INFORMATION:
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DESIGNER/ENGINEER:Not Applicable----
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Name:
MORTGAGE COMPANY: Not Applicable
Address:
Name:
City:
Address:
State:
Zip: Phone:
City:
State:
Zip:
SEA TfJRTLE
Phone:
FEE SAMPLE TITLE HOLDER: ✓'f Not Applicable
Name:
BONDING COMPANY: Not Applicable
Address:
Name:
City:
Address:
Zip: Phone:
City:
f Ztp: Phone: _.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counmakes no representation that is granting a permit will authorize the permit holder to build the subject structure
structure. Please consult with your Home Owners Association and review your deed for a
which is in conflty m
ict with any applicable Hoe Owners Association rules, bylaws or and covenants that may restrict or prohibit such
ny 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 Retard 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.
i5 gnature of Owner/ Lessee/Contractor-as Agent for Owner
STATE OF FLORIDA c,
COUNTY OF� J0_ L
The f oing instru n , was acknowledged efore me
this day of 20 LLby
(Namp-"ersop acknowledging)
{Signature of Notary Public -
Personally Known J�
Type of Identification Pro
Commission No. -.4
Revised 07/15/2014
REVIEWS
DATE
COMPLETE
INITIALS
FRONT I ZONING
COUNTER REVIEW
moicer
STATE OF FLORIDA
COUNTY OF Lu &Lf -
The fr Ing instrm t was acknowledge before me
this day of by
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{Name of eurspn ac�nowledging j
(Signature of Notary
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Personally Known rAl>
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Type of Identification Produced
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Commission No.
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SUPERVISOR
REVIEW
PLANS VEGETATION
SEA TfJRTLE
REVIEW REVIEW
REVIE
MANGROVE
REVIEW