HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �] 2
Date: Permit Number: ` 10• D 1 s3
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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 xxx
PERMIT APPLICATION FOR: Shutter
PROPOSED IMPROVEMENT LOCATION:
Address: --n R T)lo aA-o� of\ Lakes C31.�oQ
Legal Description: &S:R)r\4- 1710-nVa-A-t6 Y\ - 17YIG SU - LOE a J
Property Tax ID#: 3�a � Lot No.
Site Plan Name: Go of r V)C..�1rW0SY_A Block No.
Project Name: C3O,1 �1 V_CMCl.t)GS�C 1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
INSTALLATION OF �) MIAMI DADE APPROVED ACCORDION SHUTTERS
CONSTRUCTION INFORMATION:
itiona workto e e orme under t is permit-c ec a appy:
11HVAC Gas Tank E]Gas Piping ✓_Shutters a Windows/Doors
Electric El Plumbing O Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ (H, �n0 .YQ Utilities:Sewer ElSeptic Building Height: 15'
OWNER/LESSEE: CONTRACTOR.'
Name Name: SAMULE ZAZA
Address: UO� LDtUCS Company: JUST SHUTTER IT INC
City: t�rj, b-. LvXe� State:_ Address: 1029 SW S. MACEDO BV
Zip Code: ?JAQ-26 Fax: City: PORT ST LUCIE State:FL
Phone No. '1101 - an\- Q 1 Zip Code: 34984 Fax:
E-Mail: Phone No. 772-201-9919
Fill in fee simple Title Holder on next page(if different E-Mail: JUSTSHUTTERIT@GMAIL.COM
from the Owner listed above) State or County License: ?4293
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-SUPPLEMENTAL CONSTRUCT LIEN LAW INFORMATION:' 1
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: d
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name' Name:
Address: Address:
City: City: I
-Zip: Phone: Zip: Phone:
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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.
to
Si ature of Owner/Lessee/Co actor as Agent for Owner nature of Contractor/License Hol r
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STATE OF FLORIDA STATE OF FLORIDA,., a
COUNTY OF 61- ILAckQ_ COUNTY OF 5t I LAA9—
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this a3 day of cam1
- , 20 aby this oG day of fX �— __,,20 1-7 by
(Name of person acknowledging) (Name of person acknowledging)
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(Sign ture of Notary Pub ic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known ')0 OR Produced Identification Personally Known_ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. �� G� ( )
Notary Public State 7FOIorldaI S n NO. ��° 1 SealParrish A Nichol .A" Notary Public
State of Flo6da
Parrish A fM1 ' Expires 07/20/2021 My Commission G 126706
ols
Revised 07/15/2014 °r ,,, ;ole Expires 07/2=021
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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