HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF_JrT COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
if �74-cn-,'W
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: Window/door
"I'Llob
'X�'I Mtlli
Address: _3 \ \-'J �llt
Legal Description: 5cui-x- LUC\e__
Property Tax ID#:VAI!J--7c)I-DS_Z 6. C-404 Lot No. 3 113 z
Site Plan Name: rweL Block No. 4 Z
Project Name:
Setbacks Front Back: Right Side: Left Side:
N
REPLACE WINDOWS r J9=6 WITH IMPACT. SIZE FOR SIZE.
CONSTRU0*
-Aw
t
CTI F
W
RUN,
=6FROwl �111
Additional work to b—ernmerformed under this permit-check all that apply:
Gas Tank F_J Gas Piping -1 Windows/Doors
HVAC Shutters 1FV I
0 Electric E-1 Plumbing OSprinklers 0 Generator F-]Roof Roof pitch
Total Sq.Ft of Construction: Scl.Ft.of First Floor:
Cost of Construction:$ 1-7.
Utilities:0SewerF ]Septic Building Height:
A
FIVOR
IN
4" '
N
E�jr S-flEn
Name ?^ 'CV 5 ?C\Vl V- ' Name: WAYNE THOMAS BURNETT
Address:3�N-L. W b't 41 f_ 3 kV 01 Company: FLORIDA HOME,IMPROVEMENT ASSOC.
City: rnQVSr- 1>'k ec C-Q- State:FL Address: 3044 SW 42ND STREET
Zip Code: 7N q4 Fax: City: HOLLYWOOD State:FL
Phone No.!A J 9- If I Z 661A Zip Code: 33312 Fax:
E-Mail: Phone No. 954-792-4415
Fill in fee simple Title Holder on next page if different E-Mail:.PERMITS@FHAPRODUCTS.COM
from the Owner listed above) State or County License: CGC#061890
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required,
SU PLEfUIEN AL+CON TRUCTI®:N LIEN.LA`W IN` 10M
0M
DESIGNER/ENGINEER: X_Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY:1 X 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 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.
-1
s
Signa ure of Owner/Le ee/Contractor as Agent for Owner Sig f rector/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrigrient was acknowledged before me
this_day of 20 _by this day of
,i0�`"Y'°� •, JANETTE L LUNN
WAYNE THOMAS BURNETT MY COMMISSION#GG03 5
EXPIRES;�,t'. .•pr:
OF 6L. Ativast202 11
(Name of person acknowledging) (Name of person acknowledge g— ( A" 'Al )�1_�
)
(Signature of-Notary Public-State of Florida) (Signatu f oar li4 State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification ProdT pe of Identification Produced
o�•� Notary Public State of Florida
?
Commission No. N� 1`004co M Almeida mmission No. (Seal)
01 c � My Commission GG 139459
'?«,off' Expires 08129/2021'
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS