HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
J1 _
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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: Shutter
PROPOSED IMPROVEMENT LOCATION:
Address: 9624 Crooked Stick Lane
Legal Description: POD 18 AT THE RESERVE PUD II
Property Tax ID#: 3327-711-0013-000-0 Lot No.6
Site Plan Name: Block No.
Project Name: Pereira
Setbacks Front_X Back: X Right Side: X Left Side: X
DETAILED DESCRIPTION OF WORK:
Install 1 Roll Shutter and 17 Accordion Shutters
CONSTRUCTION INFORMATION:
Additional work to e er orme under this permit—check a that apply:
�HVAC 11 Gas Tank Gas Piping Shutters ❑Windows/Doors
Electric ❑ Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 15168.00 UtiIitiestSewer ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Dona&Sam Pereira Name: Michael Heissenberg
Address:9624 Crooked Stick Lane Company: Expert Shutter Services
City: Port Saint Lucie State:FL Address: 668 SW Whitmore Dr
Zip Code: 34986 Fax: City: Port Saint Lucie State: FL
Phone No.407-234-7081 Zip Code: 34984 Fax:
E-Mail: Phone No. 772-871-1915
Fill in fee simple Title Holder on next page ( if different E-Mail: Haleigh@ExpertShutters.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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Tilteoo Inc. Name: _
Address:6355 NW 36tn ss Suite 305 Address:
City:. Virginia Gardens State: FL City: State:
Zip: 331ss Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x 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 ruses, 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 auditions,
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 inspectiop. If you inteno to obtain financing, consult with lender or an attorney efore
commencing work or rvQ16rdlim yourKotice of Commencement.
00
Signature of Owner/Lessee/Contract as Aqbnt for Owner Signature of Contractor/License Holder
STATE OF FLORMA STATE OF FLORIDA
COUNTY OF COUNTY OF _ k i ef
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_ZZ day of 20 n by this ZZ day of ,] j Y-),C 20 L__J_by
Michael Helssenbk Michael Hsissenberg
(Name of person acknowledging} blame of person acknowledging)
(Signature V
otary- Public-State of Florida) { ignature f otary Public-State of Florida}
Personally Known v OR Produced Identification Personally Known V/ OR Produced identification
Type of Identification Produced Type of Identification Produced
Commission N�-,�C`n K)li 319 Halelgh Russell Commission No. q qj (Seal)
NOTARY PUBLi Hak igh Russell
T L IDA NOTARY PUBL
. Corms GG101 3W STATE OF FL OA
Revised 07/15/2014 Expires 5125/2U2'1 Cornrri#GG1083
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