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HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2.300 Virginia Avenue,Fort Pierce FL 34982 i
Phone:(772)462-1553 Fax: (772)462-1578 Commercial I Residential
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PERMIT APPLICATION FOR:
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PROPOSED„IMPftOVEM, NT LaCAfIt7N !
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Address: 4310 CHRISTENSEN RD,FORT PIERCE,FL 34981 !
Legal Description: j.
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Property Tax ID#:2432-423-0001-010-2 Lot No.
Site Plan Name: Block No.
Project Name:JACK& LAURIE MODINE
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Setbacks Front Back: Right Side: Left Side
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REPLACE 9 WINDOWS & 1 DOOR
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CON5TRU,CTION INFORIUI�4'T �x
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�.d Additionalwor to^ 'e er orme un er this permit—c ec a apply:
HVAC Gas Tank Gas Piping OGenerator
Shutters ! X Windows'
Doors
❑ g ❑ /
❑Electric ❑_PlumbingSprinklers ❑Roof
Total Sq.Ft of Construction: Scl.Ft.of First Floor:
Cost of Construction:$ 11,030.88 Utilities: Sewer Septic I Building Height:
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E'OINNERfLES5EE "ya COiVTRACrtOR'
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Name JACK&LAURIE MODINE Name.SCOTT PETAK
Address: 4310 CHRISTENSEN RD Company:STATEWIDEIWINDOWS&DOORS,INC.
City: FORT PIERCE State: FL Address:3417 W WOOLBRIGHT RD
Zip Code: 34981 Fax: City:BOYNTON BEACH State:FL
Phone No, 772-462-4003 Zip Code: 33436 Fax:
E-Mail: Phone No. 561-262-141i''
Fill in fee simple Title Holder on next page( if different E-Mail: XK /�y��A tWtc�z)yyj[X��Wincf'ou ,Ccvrl
from the Owner listed above) State or County License:SCC131151898
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If value of construction is$2500-or more,a RECORDED Notice of Commencement is required.; "
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SUPPLEMENTAL"CQNSTRIJCTIQN LIEN LAW`INFORMATiQN „ a , . ' j; 4
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:. _Not Applicable
Name: Name: j
Address: A Address:
City: State: City: State:
Zip: one: Zip: I ih ne•
FEE SIMPLE TITLE TLDEf: _Not Applicable BONDING COMPANY: Not Applicable
Name: A Name:
Address: Address: I
City: City:
Zip: Phone: Zip: Pi one:
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I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holderto build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenantsthat 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.
�ignature of owner/Agent/Lessee Signature of ontract r/License Holder
STATE OF FLORIDA STATE OF FLORIDP
COUNTY OF_ COUNTY OFJ30?
The forgoing instrumlent as acknowledged b ore me The f r9oing instrument w s acknowledge before me
this day of 20 by this day of 14.�� ;20 by
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1,oungl © i-�- i
{Name of person ackn i ging (Name of person acknowledging)
(Signature of Nota lic-State of Florida) {Signature of Notary'Public-State of Florida}
Personally Known t/ OR Produced Identification Personally Known j ORS Produced Identification
Type of Identification Produced Type of ldentifi IR i ro use
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Commission No. Co mission N .'- . :`= MY-COMMISSIOl�a 991106
JAMES HOWE L IREs Ma��1�j, 020
FC_Zo �l)
M`;COMMISSION#FF2 6672 'rope ``�, _
1407)398-0153 FloddallotaryServke.com
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Sept ?7,"AIQ
Revised.07/15/2014 '
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION; SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ; REVIEW REVIEW
DATE
COMPLETE j
INITIALS
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