HomeMy WebLinkAboutCompleted ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION:
Address: 151 Pepper Lane, Jensen Beach, FL 34957
Legal Description: BAY TREE LOT 4 (OR 841-2489)
Property Tax ID #: 4511-503-0010-000-8
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove and replace 16'X T overhead sectional garage door.
Residential
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work toa nerformed under tis permit –check all appy:
HVAC Gas Tank Gas Piping _ Shutters ✓Q Windows/Doors
Electric 1:1 Plumbing Sprinklers Generator Q Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1,880.00
S Ft. of First Floor:
UtilitiestSewerE]Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Hobert e onen
Name: evin H MatyjaszeK
1 Pepper Lane
Address:
Company: Excelsior Construction & Roofing
city: Jensen Beach State:
Address: 1882 SE Crow—bed—rry-0—rive
_
Zip Code: 34957 Fax:
City: Port t. UCie State:
914-469-80T-4
49 772 -618 -66 -6U -
- 18-666
Phone No.
Zip Code: Fax:
772-418-88-0-9
Phone No.
E -Mail:
E -Mail:
Fill in fee simple Title Holder on next page ( if different
E -Mail: info exce siorconstruction.net
from the Owner listed above)
State or County License: CG 1 911
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
The forgoing instrument was acknowledged before me
Address:
this jfA day of April 12013 by
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
(Signature of otary Public -S at F.c CHRYSTALGOMEZ
City:
Commission No.'FF%33�4 `• AMY OMMISSION#FF2033
EXPIRES: February 24,20
City:
n,r�OF
Zip: Phone:
FL4' Borded Thru Budget Notary Smite
Zip: Phone:
REVIEWS
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.
Signature of Own Lesse'6'/Co nt[Aaor as Agent for Owner
Signature of Contract icense older
STATE OF FLORIDA
STATE OF FLORIDA
I
COUNTY OF S+. I_U4re
,
COUNTY OF Z&, -,,e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this jfA day of April 12013 by
this _"i day of ADA. 20JS by
X441
&/A) ,e. AQ4('a62cZ
Name of person aking statement
Personally Known OR Produced Identification
Name of perso aki g statement
Personally Known �mOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
c�
(Signature of otary Public -S at F.c CHRYSTALGOMEZ
(Signature o otary Publi to of�lorida �HRYSTALGOMEZ
Commission No.'FF%33�4 `• AMY OMMISSION#FF2033
EXPIRES: February 24,20
Commission NoTF2 * CO ISSION#FF 203322
�: February 24, 2019
n,r�OF
�J
FL4' Borded Thru Budget Notary Smite
41 Bonded Thru Budget Notary Swim
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17