HomeMy WebLinkAboutCompleted ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 314�'l 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: 6011 Myrtle Drive, Fort Pierce, FL 34982
Legal Description: INDIAN RIVER ESTATES -UNIT 08- BLK 66 LOT 29 (MAP 34/11 S) (OR 1023-181)
Property Tax ID #: 3402-609-0527-000-2 Lot No. 29
Site Plan Name: Block No. 66
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove and replace 16'X 7' overhead sectional garage door.
CONSTRUCTION INFORMATION:
—Additional work to be erformed under this permit— check all h appy:
HVAC Gas Tank Gas Piping_ Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 1550.00
SFt. of First Floor: _
Utilities:]Sewer OSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Susan Laventure
Name: Kevin R. Matyjaszek
Address: 6011 Myrtle Drive
Company: Excelsior Construction & Roofing
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No. 772-323-5778
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: susan.laventure@att.net
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
it value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: kl 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 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 your Notice of Commencement.
Signature of Ow4f/ Le e/Contractor as Agent for Owner
i
Signature of Co r ctor Lir- ccense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF \UC -1 e-
COUNTY OF SA- Xu C, Le
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged efore me
this _�ay of MC4,f 6%, 20 JR by
this IL1�Jay of IA Ca fill 20 1-tby
Name of pers n making statement
Name of person making statement
Personally Known q OR Produced Identification
Personally Known J OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature Notary Pu is- * f.14prida MRYSTALGOMEZ
(Signature f otary Public- to tori a )
MY COMMISSION # FF 203322
Commission No.LF26 *(1! RAES: February 24, 2019
ar r0
Commission No. �F�0338'�°�.'":�`� all
Bonded Thru Budget Notary Smites
* MISSION I FF 203322
EXPIRES:
EXPIRES: February 24, 2019
+, ""'0' Bonded Ther Bridger Notary Sues
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17