HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ia 10.J)7 Permit Number:
- = i.
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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 ✓
PERMIT APPLICATION FOR: Window/door
Id—
PROPOSED IMPROVEMENT LOCATION:
Address: 89 Aqua Ra Drive, Jensen Beach, FL 34957
Legal Description: RIVER WATCH BILK 4 LOT 5 (OR 1028-2764:1063-2966)
Property Tax ID #: 4511-815-0014-000-4
Site Plan Name:
Project Name:
Setbacks Front Back: -
Right Side: Left Side:
Lot No.5
Block No. 4
I DETAILED DESCRIPTION OF WORK: I
Remove and replace 14' X 7' overhead sectional garage door with new DAB door.
CONSTRUCTION INFORMATION:
Additional work toe verformed under this permit— check a apply:
HVAC Gas Tank E]Gas Piping _ Shutters Windows/Doors
❑ Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 1550.00
SFt. of First Floor: _
Utilities:] Sewer 11 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Patricia A Barlow
Name: Kevin R. Matyjaszek ;
Addrbss:89 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 Applicable
N a m e: Patricia A Barlow
MORTGAGE COMPANY: Not Applicable
N am e: Kevin R. Matyjaszek
Address: 89 Aqua Ra Drive
Address: 89 Aqua Ra Drive, Jensen Beach, FL 34957
City: Jensen Beach State:
Zip: Phone
City: Port St. Lucie State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address: 1882 SE Crowberry Drive
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 vour Notice of Commencement.
Signature of O i/ L ssee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF sl� LG�G ce
The forgoing instrument was Icknowledged before me
this day of pEGe )2r , 20_LZ by
a44 L4wd
Name of person faking statement
Personally Known 70R Produced Identification
Type of Identification
Produced
4,1,gture of o ry Public- Stat C Si
_ CQMMIAIISSION # FF 2322
�f T �U3 s� �S RES:Febtun►y24,2019
4, OF F�dw`c 60 fttg
Commission NoT%i1012ty $W"
Signature of Co6t!ractorfricense Holder
STATE OF FLORIDA
COUNTY OF Sf. I te-i'C
The forgoing instrument was a knowledged before me
this 10 day of 20 /;r by
APNrnl �/45aew
Name of perso making statement
Personally Known OR Produced Identification
Type of Identification
Produced
c L C�Q —A ��
(Signature of No ar Public- State o da )
CWWALOM
Commission No. �� �03`a•a�p' *ay#
EXPIRES: Flitit sly 24,
�''FOFf�o�`� Neod�tTnniilu0ydtirfiryE
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17