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ALL APPLICABLE IN O M ST Bf COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 Permit Number:
•
-- 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
�PROPOSE`DIVII?R®VEMENTL®CAT � >` ,_,,
Address: -701 l!ZM -?09:r_ gr clE rt Sgge9 ,
Legal Description: 14a,k L4iQbW6- kr-TI F kfS'6e�67 LOf 000.1
PropertyTax ID#: _5321-TOS-00C/5--000-3 Lot No. 190 _
Site Plan Name: .'rUaLt-/ Mc-ri rR_ Ab) Block No.
Project Name: 11611 1FAWA"N
Setbacks Front Back: Right Side: Left Side:
DE�TAILED�DESxCR�IPTION
I.WORKS
xi . .ax: ..�
REPLACE WWWROORRES Z DOORS WITH IMPACT. SIZE FOR SIZE.
C®NSTRIJCTION IRII=ORM/��TIONr - `
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Additionalwork to be e Orme un er this permit c ec �a appy:
HVAC Gas Tank FIGas Piping Shutters Q Windows/Doors
11Electric 0Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ /2/ 7615 Utilities:llSewer Septic Building Height:
fzRotf� � _ NTRACTOR "
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Name 3 UD ITH M GTI ERj.,.c►�1 ® Gt YNE THOMAS BURNETT
Address: -AM49 M&K-5N T;E2 Company: FLORIDA HOME IMPROVEMENT ASSOC.
City: ?o2'f ST L UGI E State:FL Address: 3044 SW 42ND STREET
Zip Code: 319% Fax: City: HOLLYWOOD State:FL
Phone No. 'VP*Z 64Z 4o�3 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
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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PCEIVIENTACONS ,UCTI;ONLtLAWIfFORMATIC) t'� _§
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DESIGNER/ENGINEER: x Not Applicable � MORTGAGE COMPANY: X Not Applicable
Name: Name: �''
Address: Address: `i
City: State: City: ;i State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY:. 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 toilanother 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 Comme eme t.
s
Sig r caner/Lessee/Contractor as Agent for Owner Sig u ntractor/Lice'nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 5A,"'r LueIE
The forgoing instrument was acknowledged before me The forgoing instrument was!acknowledged before me
this day ofd 20 Mby this)-'A day of
':: A -ETTE L LUNN
MY COMMISSION#GG032 5
WAYNE THOMAS BURNETT : -!VO't0' EXPIRE 02
(Name of person acknowledging) (Name of person acknowledgi
Av&\, A
(Signature of Notary Public-State of Florida) (Sign ure f Notary Public-'! ate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. °e..4, (("4ELA LEMOS Commission No. (Seal)
MY GUMMISION#GG135619
EXPIRES:AUG 17,2021
Banded roug st State Insurance
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS