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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //'��
Date: Permit Number: 10 '0111 o S
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: 405 Gregory St
Legal Description: Indian River Estates- Unit 04-Blk 37- Lot 17
Property Tax ID#: 3402-605-0107-000-0 Lot No. 17
Site Plan Name: Block No. 37
Project Name: Jacobs Residence
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION.INFORMATION: ']
Additional work toe performed under this permit—check a appy:
HVAC E] Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Oloof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:,
Q3a
Cost of Construction: $ Utilities: _Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Jeffrey&Rebecca Jacobs Name: Edward J Heritage
;Address:405 Gregory St Company: Folding Shutter Corporatibn
;City: Fort PierceState:FL Add.res,s: 7089 Hemstreet'PI
34982. West Palm Beacfi, FL
Zip Code: Fax:' City: State:
Phone No.772-468-3158 Zip Code: 33413. Fax: 561-640-8204
E-Mail: Phone No. 561-683-4811'
Fill in fee simple Title Holder on next page (if different E-Mail: info@foldingshutters.com
from the Owner listed above) State or County License: .SCC131151041
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
r
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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 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.
, - ',- S
kSign atureXof�� Owned' Less Agent for.Owner wS�gnatwre f�C� on� older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY OF PALM BEACH
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledgedbfore me
this �ay of OGT 20 �by this a day of QL ,20 by
EDWARD J HERF+AGE EDWARD J HERITAGE
(Name of person acknowledging) (Name of person acknowledging)
O _
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known XX OR Produced Identification Personally Kriown - OR Produced Identification
Type of Identification Produced Type of Identification Produced
F�IS6f14 �7
Commission No. � (Seal Commission No.r Ft�o�4( (Seal)
��tt�Y ass ELA A.EV
NOTARY PUBLICS AItY PAMELA A.EVANS
ST yPUBLIC
Revised 07/15/2014 y a Comm#FF150967 -+STATE OF FLORIDA
•SINCE 19�� Expires 10111/2018 s�Nc ,�i Comm#FF150967
018
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