HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABL INF MUT E7PLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: //
12
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
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PERMIT APPLICATION FOR: Shutter
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Address: 5512 CASSIA DR
Legal Description: INDIAN RIVER ESTATES-UNIT 09-BLK 72 LOTS 18 AND 19 (MAP 34/12N)(OR 1063-277)
Property Tax ID#: 3402-610-0076-000-9 Lot No.
Site Plan Name: Block No.
Project Name: NIEWIEROSKI
Setbacks Front X Back: Right Side: Left Side: X I
INSTALL 8 ACCORDIAN SHUTTERS, 2 MILL PANELS AND 1 CLEAR PANEL SHUTTER.
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Additional work to be Derformed un er t'is permit—check all appy:
HVAC Gas Tank ❑Gas Piping o_Shutters Q Windows/Doors
Electric ❑Plumbing Sprinklers F Generator I❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 3,074.00 Utilities. _Sewer E]Septic Building Height:
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Name Valerie A Niewieroski Name: Michael Heissenbdrg
Address:5512 Cassia Dr Company: Expert Shutter Services
City: Fort Pierce State:FL Address: 668 SW Whitmore Dr
Zip Code: 34982 Fax: City: Port Saint LucieState:FL
Phone No.772-466-3437 Zip Code: 34984 Fax: 772-871-0990
E-Mail: Phone No. 772-871-1915 j
Fill in fee simple Title Holder on next page(if different E-Mail: Callexpert@aol.com
from the Owner listed above) State or County License: 16572
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
LEIIEN � 'CNSfiTIOI� I 1:1�4N�ll MATIC� �� f � F£ I : � n
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:-rk�)3= Name:
Address: ress:
City ; State: City: State:
Zip: �_LU Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY:'- Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 respe'Icts,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 an'other 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 inspe tion. If you intend to obtain financing, consult with der or an attorney before
commencing worJe or rec our ice of Commencement.
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Signature of Owner/Lessee/Contra r as A nt for Owner Signature of Contractor/License Holder
STATE OF FLORIDA, STATE OF FLORIDA
COUNTY OF�C—>r��t,( .(A--C COUNTY OF
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisdayof JU20 n—by thisIzzdayof `LA01� 20 by
Michael Heissen4g Michael Heissenberg
(Name of person acknowledging) (Name of person acknowledging)
Sig ature f N tary PubliS-State of Florida) ignature doVn
ry Public-75tate of Florida)
Personally Known OR Produced Identification Personally Kn .,/ OR'Produced Identification
Type of Identification Produced Type of Identification Produced
Halelgh Russell
Commission No�� NOTARY PUBLI Commission Noelcal(� �� agalelgh Russell
STATE OF FLO IDA OTARY
PUBLIC
j c` 'STATE OF
Revised 07/15/2014 Expires 5/25/2021 COm GG108399
Expires 5/25/2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION,, SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMP LETE
INITIALS
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