HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4a IO / 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
PERMIT APPLICATION FOR: Window/door El
PROPOSED IMPROVEMENT LOCATION:
Address: 81 Aqua Ra Drive, Jensen Beach, FL 34957
Legal Description: RIVER WATCH BLK 4 LOT 1 (OR 3668-2812)
Property Tax ID #. 4511-815-0010-000-6
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove and replace 14'X 7' overhead sectional garage door with new DAB door.
t�K
Lot No.1
Block No. 4
CONSTRUCTION INFORMATION:
Additional work to El
r orme un er t is permit— c ec a app y:
HVAC Gas Tank E]Gas Piping _ Shutters ✓� Windows/Doors
❑ Electric ❑ Plumbing ❑ Sprinklers Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1700.00
SFt. of First Floor: _
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Kathleen Paparone
Name: Kevin R. Matyjaszek
Address -.81 Aqua Ra Drive
Company: Excelsior Construction & Roofing
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No.
Address: 1882 SE Crowberry Drive
City: Port St. Lucie State: FL
Zip Code: 34983 Fax: 772-618-6660
Phone No. 772-418-8809
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: info@excelsiorconstruction.net
State or County License: CGC1521911
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not
Name: Kathleen Paparane
Applicable
MORTGAGE COMPANY:
Name: Kevin R. Malyjaszek
Address: 81 Aqua Ra Drive
Not Applicable
Address: 81 Aqua Ra Drive, Jensen Beach, FL 34957
City: Jensen Beach
Zip: _Phone
State:
City: Port St. Lucie
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
of Applicable
Address: 1882 SE Crowberry Drive
Address:
City:
Zip: _Phone:
City: --
Zip: Phone:
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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
commencingwork or recordingour Notice of Commencement.
RECEIVED
Signature of er/ L ssee/Contractor as Agent for Owner
Signature of Contra t r/License Hold r
STATE OF FLORIDA �
STATE OF FLORIDA / ,
COUNTY OF Sf. Latae
COUNTY OF S� G-ccGie
The forg ing instrument was cknowledged before me
The forgoing instrument wa acknowledged before me
this �jday of e 20f7 by
this f�day of a CK a 20 /7 by
KP,►/idJ R.
��eU/.�/ l� . /Z4�ti/as _�/
Name of person aking st ement
�
Name of perso making tatement
�
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
urni a �
(Signature of N tart' Public- Sta Q_'.
(Signature of N art' Public- State F da
r��1
Commission No�rd�3 3 a ( ��RRY�A"
* * f���tlMkNS910NbEF�D22
��`.•••:;� txiRYSTAL,t�OtYIZ
Commission No. c aO33a i�0"'M • Y�l����
„X I�ES:F�wry24,20EXPIRES;
Fabrttary
Rev. 8/2/17
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not
Name: Kathleen Paparane
Applicable
MORTGAGE COMPANY:
Name: Kevin R. Malyjaszek
Address: 81 Aqua Ra Drive
Not Applicable
Address: 81 Aqua Ra Drive, Jensen Beach, FL 34957
City: Jensen Beach
Zip: _Phone
State:
City: Port St. Lucie
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
of Applicable
Address: 1882 SE Crowberry Drive
Address:
City:
Zip: _Phone:
City: --
Zip: Phone:
24,I!Ot9�ndea
✓'�'��
t7au BWpN i�ry s
�,�`� iNir WAget MNry S�Ie1
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED