HomeMy WebLinkAboutBuilding Permit Application 4
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� ' Q ' )-7 Permit Number:
s V ,r : t RECEIVED
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Building Permit Application OCT 3 0 2017
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: To Select from dropbox, click arrow at the end of line
sPR®POSED 111ttPROVEMENT ,OCATtO
Address:_ I -,X �-T n di-/!i/Yl R.-'V f! r 1) r-
Legal Description: 18 36 41 That part of N 110 Ft of lot 3 lying E of A Line 300 ft W of and//to W R/W Line of S IRD-Indian River
Drive-less Rd R/W-w/rip RTS (20-A)(or 3576-1778)-windows only
Property Tax ID#: 35183110004002 Lot No.
Site Plan Name: Hurricane Improvements and Mechanical Access Block No.
Project Name: Impact Windows
Setbacks Front Back: Right Side: Left Side:
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ODE�AILEO DESCRIPTIO
"VEN,', y � y x J'3 ,
N OF WORK.
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New hurricane windows, -¢ V1 , V1
;CONSTRUCTION 1NFORMTLON t
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Additionalworkto e e orme under this permit-c eca appy:
HVAC L_I Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric ❑ Plumbing Sprinklers ElGenerator 11 Roof Roof pitch
Total Sq. Ft of Construction: 644 S Ft.of First Floor:
Cost of Construction:$ $2,324 Utilities: Sewer Septic Building Height:
171
OrIVNER%LESSEE x _ t (3NTRAG ORz�
Name Tim Derosier Name: JL-'r (8R6b-ZlaS1-1
Address:7548 S US 1 3216 Company: jHE FIV ISg WG TOUC4, LLC_
City: Port St Lucie State:FL Address: !3�a®S MAWErkA"F -PLG
Zip Code: 34952 Fax: City: PQAT' ST Lc.c1 r State:_FL
Phone No.772-626-9191 Zip Code: Fax:
E-Mail:thederosiers@gmail.com Phone No. -772 L4 WL 5TIL
Fill in fee simple Title Holder on next page(if different E-Mail:�-JL=Fp5(-iA/ISF11A�fG` LXq t9- G�AIL.Com
from the Owner listed above) State or County License: C F'C 1330 3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCT{ON LtfN LAW (NFQRMgT10N F
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:Tim oerosier Name:
Address: Address: 7548 S US 13216
City: PortSt Lucie 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:
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 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.
Signa re of ner/6eisseeflContraictor as Agent for inner natur Contractor/ cense Holder Q rN
STATE OF FLORI ' �5 jz STATE OF FLORIDA
COUNTY OF COUNTY OF > y o ,
226
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The forgoing instrupp��e t as acknowledged before n u5s - The f oing instr den was acknowledged before me' ¢�X
this ay of lJ 2017 by this day of 20/�by X11' o
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Name f person making statement Name o person making statement =•.
c.*..rob., C.PY*••'�4
Personally Known OR Produced Identificati Personally Kn n OR Produced Identification
Type of Iden t' ca ' n =;: :o Type of Identi 'ca 'o
,,f A p moo,;. ,.
Produced (7VY ' c.C�l C. I ' 4 Produced L
60) PA�v 1
Z21211VAI-11 - L"Z I A- s I -
(Signature of No a Public-State of Florida) (Signature of Nota r
ublic-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17