HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED.FOR APPLICATION TO BE ACCEPTED
Date: 9-22-2017 Permit Number: 1160v O3s 0
RECEIVED SEP 22 1017
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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
PERMIT APPLICATION FOR: Window/door
PROPOSED`IMPROVEMENT LOCATION:
Address: 930 Jackson Way Ft.Pierce
Legal Description: Coastal Coves-Unit 1-Lot 1(or 1243-723)
Property Tax ID#: 1423-802-0004-000-2 Lot No.1
Site Plan Name: 929 Jackson Way Block No.
Project Name: Grigsby
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace 16 x 7 Garage Door Size for Size (Hurricane Damage)
CONSTRUCTION.INFORMATION:
Additional work to be ertormed under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers ElGenerator E] Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost.of Construction:$ 2,260 Utilities:Sewer ElSeptic Building Height:
OWNER/LESSEE: .; CONTRACTOR:
Name Susan Grigsby Name: Mitchell O.Pierce
Address:930 Jackson Way Company: Quality Garage Door Services
City: Ft. Pierce State:Fl_ Address: 116 S.Park Ave
Zip Code: 34949 Fax: City: Titusville State:FI.
Phone No.772-475-1352 Zip Code: 32796 Fax: 321-264-6399
E-Mail: Phone No. 321-264-6399
Fill in fee simple Title Holder on next page(if different E-Mail: Qualitygaragedoorservices@yahoo.com
from the Owner listed above) State or County License: CRC1329903
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: _Not Applicable
Name:Susan Grigsby Name:Mitchell O.Pierce
Add ress:930 Jackson Way FL Pierce Address: 930 Jackson Way
City: Ft.Pierce State: City: Titusville State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:116 S.Park Ave Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced priof 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 Nf4ice of Commencement must be recorded and posted on the jobsite
before the first inspe do If ante d to obtain financing, consult wit de an attorney before
commencingwor r o Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA-- f1
COUNTY OF Sk. �-oc �� COUNTY OF c�e,Vf�r
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Q:;Lday of ,20�L by this�_4iay of 20_n by
mac c Int �1 Q ��-c.(i;,e, )',k -AX 0\,\ 0 . 14I U_
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known �< OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Nota S nature of Nota, Public- fib
DEANNAMAR
• a�•• t S51cN#M zzozs .• •� , LISA A TINI}ALL
Commission Co. � �2o Commission N MISSION(g OP24256
Uecemb
hN Notary
PublicUnderv+riterr '.'� EXPIRES August 24,2020
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION , SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17