HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:AUGUST 25,2017 Permit Number:
Planning and Development Services Building Permit Application
AUG 2 5 20!1
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential YES
PERMIT APPLICATION FOR: Window/door
PROPOSED,IMPROVEMENT.LOCATION:
Address: 9506 CROOKED STICK LANE PORT ST.LUICE,FL.34986
Legal Description: POD 18 AT THE RESERVE PUD 11 FIRST REPLAT(PB 43-14)'LOT 41A{OR 2875-2981:2905-2089)
Property Tax ID#: 3327-804-0005-000-6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
REPLACE FRONT ENTRY DOOR WITH 1 SIDE LITE. SIDE LITE IS NON IMPACT GLASS BUT HAS
EXISTING STORM PANELS FOR IT.
[C:O:NSTRUCTION INFORMATION:
Additional work toe nertormed under tis permit—checl all appy:
0 HVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric 0 Plumbing Sprinklers a Generator Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 1,500.00 Utilities:0Sewer ElSeptic Building Height:
.01NNER/LESSEE: CONTRACTOR:
Name KAVEH GHAZI Name: JAY BENNY
Address:1661 RIVERSIDE AVE.#305 Company: PINNACLE SOUTH BUILDERS INC
City:JAXSONVILLE State-- Address: 3765 SW HULSKA ST_
Zip Code:32204 Fax: City: PORT ST.LUCIE State:FL.
Phone No.904-518-0125 Zip Code: 34953 Fax:772-343-8910
E-Mail: Phone No.772-528-4423
Fill in fee simple Title Holder an next page(if different E-Mail: JAYBENNY@BELLSOUTH.NET
from the Owner listed above) State or County License: CBC1254149
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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Y
SUPPLEMENTAL_CONSTRUCTION.LI.EN_LAW INFORMATIQN
r
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:rAvEH cepa Name:JAY BENNY
Address:9506 CROOKED sTIcK LANE PORT STLuIcE•A 349N Address: 1661RHfERSIDEAVE-065
City: JAXSOWIIE State: City: PoRrST uUaE State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:3765 SW HULSKA ST. Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permitto do the work and installation as indicated.
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 w►th 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,wails,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 b Q . 'rfris'" cement.
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Signatu f Own r Lessee/Contract Agent for, }purer Signature of ntra r/License Holder
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STATE Fl. A
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The forgoing instrument was acknowledged before (& The forggig instrument was acknowledged before r j �'�j
thi day of 20� by n = thi ay of 20.a byCn
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ame of person makin tatement Na of person making stat ment ,
er on y Known OR Produced Identification er nal o n OR Produced Identification
e of Iden ifi tion T e of Iden ' ca
Produced a%� - `'�^ roduced �'• "�
(Signature of N ry Public-Siaa of Florida) 0 (Signature of Noo Public-State of Floridg)
Commission N (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17