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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 910 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 V PERMIT APPLICATION FOR: Window/door PROPOSED IMPROVEMENT LOCATION: Address: 2109 NW Greenbriar Lane, Palm City, FL 34990 Legal Description: GREENBRIAR VILLAGE HARBOUR RIDGE -PLAT 2- UNIT 17 (OR 3986-1908) Property Tax ID #: 4425-701-0053-000-5 Site Plan Name: Project Name: Setbacks Front Back: Right Side: Left Side: Lot No. Block No. DETAILED DESCRIPTION OF WORK: I Remove and replace 18'X 7' overhead sectional garage door. CONSTRUCTION INFORMATION: Additional work to be erformed under tispermit—check—allappy: HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors 11 Electric Plumbing Sprinklers Generator 1:1 Roof Roof pitch Total Sq. Ft of Construction: Cost of Construction: $ 2,aOO ©o Sq, of First Floor: _ Utilities: I _ISewer 0Septic Building Height: OWN ER/LESSEE: CONTRACTOR: Name Christopher & Cordelia Jennings Name: Kevin R. Matyjaszek Address: 2109 NW Greenbriar Lane Company: Excelsior Construction & Roofing City: Palm City State: FL Zip Code: 34990 Fax: Phone No. 717-576-3227 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 11 value or construcuon is >zwu or more, a KLCUKDLD Notice of commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: �✓ Not Applicable Name: MORTGAGE COMPANY: I/ Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable Name: BONDING COMPANY: Not Applicable Name: Address: 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 thepermit 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. Signature of Ow Less /Contractor as Agent for Owner Signature of ContraCter/Licen4&Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF ': I+ I k - k -C l COUNTY OF '. f- I LCC L -� The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this Ql 'bay of 20 by this 2218ay of fk c 20i2> by - , Ili �u) gs z / ,leij;Aj R ly4 � is 'IS ze' Name of person kint atement Name of person making sta ent Personally Known OR Produced Identification Personally Known L.�OR Produced Identification Type of Identification Type of Identification Produced Produced (Signature of N Lary Public- State of . a ) (Signature of airy Public- Stat,, i a) �� . • • •. CHRYSTAL GOMFl 2 t �QMMISSION A FF 203322 Commission No. �� 2©3 2, ( �{{ ES: February 24, 2019 o.���.� CHRYSTAL GOMEZ Commission No. of)CQMMISSIONiFF2033 20 33 2 2 2 "�'� Se *EXPIRES: BondedThru 4udget Notary Services February 24,20 r,+rfa F�oRO! %MedThru Budget Notary Se REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17