HomeMy WebLinkAboutCompleted ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 / Permit Number:
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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:
647 Ponvtail Lane. Fort Pierce. FL 34982
MUM CDD.
Legal Description: PALM GROVE S/D BLK E LOT 25 (0.12 AC) (OR 3196-2877)
Property Tax ID #: 3410-503-0162-000-5
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove and replace overhead sectional garage door.
Lot No.
Block No.
Additional work to be ertormed under this permit —check all apply:
HVAC [] Gas Tank Gas Piping 1:1_ Shutters ✓a Windows/Doors
1-1 Electric 11 Plumbing HSprinklers [] Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: Sci. Ft. of First Floor:
Cost of Construction: $ 2,330.00 Utilities: 0 Sewer 0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Robert ns le
Name: eVln a yjasze
Address:637 Ponytailane
Company: Excelsior Construction & Roofing
City: FOR Pierce State:
Address: 1882 SE Growberry Drive
_
Zip Code: 34982 Fax:
City: Port St. Lucie State:
Phone No. 973-479-5098
Zip Code: 34983 Fax: -618-6660
Phone No. 772-418-800-9
E -Mail:
Fill in fee simple Title Holder on next page ( if different
E -Mail: info excels io rco nstructio n. net
from the Owner listed above)
11
State or County License: 9
If 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: 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.
Rev. 8/2/17
Signature of Contracto6elcensEOqolcler
Signature of Ow Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF _1VLuG/C
// --
COUNTY OF _;W^,GeGY-C
The for ping instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 6 day of AfJri/ 20by
this day of 20 by
If
A A4is 5zr�
Name of per so aking s atement
7OR
Name of perso making st ment
Personally Known Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
CQ--,
Produced
—
(Signature of N Public- ate of F rida)
(Signature of o ary Public- Sta a of )
;.•••� HRYSTALGOMEZ
Commission No. F2o332Z ( MMISSION 3 FF 203322
*
•;�� CHRYSTALGOMEZ
Commission No. FF2o3322 �J2D33
EX IBES: February 24, 2•
EXPIRES: February 24, 2019
Thru budget Notary So
oeO! Bonded Thru Budget Notary Serrlces
7F f�
F Ftoa°e Bonded
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17