HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 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
PROPOSED IMPROVEMENT LOCATION:
Address: 7356 Pine Creek Way, Port St. Lucie, FL 34986
Legal Description: 22 36 39 THAT PART OF SEC 22 MPDIN OR 552-616 AND KNOWN AS PINE CREEK TOWNHOMES
-PHASE IIB- BLDG 8 UNIT 23 (MAP 33/22N) (OR 1384-18)
Property Tax ID #. 3322-233-0023-000-1
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Remove and replace 16'X T overhead sectional garage door with new DAB door.
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be erformed under t ispermit — check all
Ithat appy:
HVAC Gas Tank ❑Gas Piping F] Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers 11 Generator Roof Roof pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 1810.00
SFt. of First Floor: _
Utilities: L =J Sewer F]Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Brad & Shirley Yates
Name: Kevin R. Matyjaszek
Address: 7356 Pine Creek Way
Company: Excelsior Construction & Roofing
City: Port St. Lucie State: FL
Zip Code: 34986 Fax:
Phone No. 772-215-3444
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: kevin@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:
Signature of Contract icen Holder
DESIGNER/ENGINEER: _ Not Applicable
Name: Brad &Shirley Yates
MORTGAGE COMPANY:
Name: Kevin R.Matyjaszek
Not Applicable
Address: 7356 Pine Creek Way, Port St. Lucie, FL 34986
Address: 7356 Pine Creek Way
The forgoing instrument was acknowledged before me
City: Port St. Lucie State:
Zip: Phone
City: Port St. Lucie
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
Not Applicable
Address: 1882 SE Crowberry Drive
Address:
Personally KnownOR Produced Identification
City:
City:
Produced
Zip: Phone:
Zip: Phone:
Signature (Signature of o ary Public- Stat for )
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.
Rev. 8/2/17
Signature of Contract icen Holder
Signature of Owner/Lc<�o ractor as Agent for Owner
STATE OF FLORIDA I
COUNTY OF 6� IU,,le
STATE OF FLORIDA
Laele
COUNTY OF :�q.
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Aday of J,2,u46aP11 208 by
this 444 day of 201 by
l�e�%y �. /ltc�{uicrs�
��i%y R. /iifg�i4sae�
person
Name of person aking s ement
Name of perso making tement
y
Personally Known Produced Identification
Personally KnownOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Signature (Signature of o ary Public- Stat for )
(Signature of Nota Public- State(
^ R •..e<� C TAL GOMEZ
Commission No. �� cZo33a� (eNMCOMMISSION #FF20332
EXPIRES: February 24, 201
pt�aY pie! CHRYSTAL GOMEZ
Commission No. t F�d�3o1 012 ' "'' * 4h COMMISSION # FF 20
February 24,
Notary Sery
EXPIRES:
Thru Budget
�l�TfOF F1AP��c Bonded Tiau Budget Notary Se
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17