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HomeMy WebLinkAboutBuilding Permit Application CsIJ ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED LIR Date: T120Permit Number: L ca 4Lri E, L' E a.✓ Building Permit Application Planning and Development Services JUN Building and Code Regulation Division pER,1-AIITING 2300 Virginia Avenue,Fort Pierce Ft 34982 SL LuciE, U_' nt?, FL Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: PROP05ED IMPROVEMENT LOCATION a 4; Address: 12521 S Indian River Dr,Jensen Beach ,F134957 • SPRING HILL BLK 2 LOTS N Legal Description. O S 1 AND 2 AND TRACT Property Tax ID#:4504-604-0014-000-4 Lot No. Site Plan Name: Block No. Project Name..Tob or Kerri Dombroski Setbacks Front Back: Right Side: Left Side: xt: 4 ,�... „3 Replacement off CV windows © doors CONSTRUCTI- N:INFORMATION y Additionalwork toa er orme un ert Is —checkpermit a appy: ❑HVAC Ei Gas Tank ❑Gas Piping _Shutters Windows/Doors ❑Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑Roof Total Sq. Ft of Construction: SFt.of First Floor: Cost of Construction:$ 14962.00 Utilities:11Sewer❑Septic Building Height: OINNERf LESSEE n s CONTRACTOR # Name Tob or Kerri Dombroski Name:Alphonse P. Campanelli Address: 12521 S Indian River Dr Company:Storm Tight Windows,Inc. City: Jensen Beach State: Fl Address:500 SW 12th Ave Zip Code: 34957 Fax: City:Deerfield Beach State:FL Phone No. 517-927-6540 Zip Code: 33441 Fax:561-292-3562 E-Mail: Phone No. 561-536-4387 Fill in fee simple Title Holder on next page(if different E-Mail: stormtightpermits(aoutlook.com from the Owner listed above) State or County License:CRC046091 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required, SUPPLEMENI"AL CONSTRUCTION LIEN'LAW-INNFORMATION: 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 thepermit 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. Si na a of Owner/Ag nt/Lessee Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20 14 by this day of 20J4 by {Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Public-State of Florida} {Signature of Notary Public-State of Florida} Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced Commission No. (Seal) Commission No. (Seal) Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS