HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: fkh Permit Number:
I / -
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 i
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION:
Address: 5804 Buchanan Drive, Fort Pierce, FL 34982
Legal Description: INDIAN RIVER ESTATES -UNIT -02- BLK 9 LOTS 16 AND 17
Property Tax ID #: 3402-603-0065-000-7 Lot No. 16 & 17
Site Plan Name: Block No. 9
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK:'
Remove and replace 16'X 7' overhead garage door.
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit— check all apply:
HVAC F] Gas Tank F]Gas Piping 11 Shutters
Electric 11 Plumbing 11 Sprinklers FIGenerator
Total Sq. Ft of Construction:
Cost of Construction: $ 1,200.00
S Ft. of First Floor:
Utilities: Sewer Septic
OWNER/LESSEE:
Nameutticer Brian Avllle
Address: 5804 Buchanan Drive
City: Fort Pierce State:h�
Zip Code: 34982 Fax:
Phone No. 772-359-8944
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof Roof pitch
Building Height:
CONTRACTOR:
Name: Kevin H. Matyjaszek
Company: Excelsior Construction & Roofing
Address: 1882 SE Crowberry Drive
City: Port St. Lucie State: FL
Zip Code: 34983 Fax: 772 -618 -6660 -
Phone No. 772-418-8809
E -Mail: kevin(o—)excelsiorconstructlon.net
State or County License: CGC 1521911
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION -
DESIGN ER/ENG IN EER:
NFORMATION:DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _j[_. 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 your Notice of Commencement.
Signature of Ovc� tor as Agent for Owner
STATE OF FLORIDA
COUNTY OF _5f. Lucie
The forgoing instrument was acknowledged before me
this _a day of lv_?v , 20 Zby
Name of e son dckn %ed in V
re of Notary'Public- State of Flo
V
Signature of Con a�®rlLice=6ff�'eHolder
STATE OF FLORIDA
COUNTY OF Sre Luef I e
The forgoing instrument was acknowledged before me
this /& day of A14K .20 /7 by
e v iQVateof
1<
(Na a of rs acknow
,Kiign ure of Notar, Public -da )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Producedry'' of Identification Produced
LTM,�Y COMMISSION # FF 935-78 I_ f � l 7 p
Commission No. `35!" ea January o rission No. U LYNNA SWA4F�
`.,., XPIRES: Janua 30, 21-2 ;_?� My COMUfSSION x FF =�'r`J
? R 1c Bonded Th u Notary Public Unden rt to s = `Y 3: '2020
e EXPIRES: January
a—do(i Thru Notary Public 1 -e- ter
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS