HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r/
Date: ��r�✓ L��I)� 20 ly Permit Number: �U(
= ism RECEIVED
Building Permit Application MAR 2 0 2018
Planning and Development Services
ST. L-ycip county, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line U
PROPOSED IMPROVEMENT LOCATION:
Address: 5203 Eagle Drive, Fort Pierce, FL 34951
Legal Description: Holiday Pines S/D-Phase 11-B-Lot 258 (Map 13/125) (OR 1147-2548: 2886-2262)
Property Tax ID#: 1312-8014-0061-000-5 Lot No.258
Site Plan Name: Jackie G Smith Block No.
Project Name: Jackie G Smith
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTION OF WORK:
Installation of Eighteen(18)Accordion Hurricane Shutters
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit—check a apply:
HVAC Gas Tank Gas Piping 'J Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction: $ 6881.00 Utilities:]Sewer OSeptic Building Height:
OWNERAESSEE: CONTRACTOR:
- - -- - -
NameJackie G Smith Name: Miriam Van Tassei
Address:5203 Eagle Drive Company: DVT Hurricane Shutters, Inc.
City: Fort Pierce State:FL Address: 3100 N Kings Highway
Zip Code: 34951 Fax: City: Fort Pierce State:FL
Phone No.772-559-1041 Zip Code: 34951 Fax: 772-794-1590
E-Mail:lash291 1 @bellsouth.net Phone No. 772-794-1581
Fill in fee simple Title Holder on next page(if different E-Mail: dvthurricaneshuttersinc@hotmail.com
from the Owner listed above) State or County License: 24394
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 our Notice of Commencement.
IL 0
Signature bf Owner/Lessee/Contractor as Agent for Owner Signature of ontractor/License older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF '
The fo oing instru t wa acknowledge before me The for oing instrument wa acknowledge efore me
this�day of �►r 20Z by this day of 20-L6- by
' I
Mi Ci IArny ql SCP, Vit Iii I'1 YYt ��t\I Se
Name of pers n making statem t Name of person making statement
Personally Known OR Produced Identification Personally Known��OR Produced Identification
Type of Identification Type of Identification
Produced f f Produced
i C�—
(Signature of 'c-c��tp of rinfida (Signature of Notary Pu li
KAREN S. NIE,'44SEN ;;; EN S• NIELS
Commission N =�ar scion irl1 5637 Commission No. a C° i�q on#FF 1 15 37
My Commission Expires Co
yJummission Expires
••'.,;,;��; ``' June 12, 2018 ne 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17