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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -Date: /9 1i Permit Number: in6 07'
6743 11110
COUNTYFLORIDA /n�/'A
Building Permit Application P 20,8
Planning and Development Services and Code Regulation Division ��nt.ary Coyq
Buildingent
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
PROPOSED IMPROVEMENT,LOCATION:
Address: 128 Blue Grotto Drive, Fort Pierce, FL 34945
Legal Description: PALM BREEZES CLUB (PB 49-32) BLK 4 LOT 13 (OR 3601-1665; 3602-2612)
Property Tax ID#: 2310-500-0107-000-3 Lot No. 13
Site Plan Name: Richard Denmon Block No. 4
Project Name: Richard Denmon
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: - -
Installation of Hurricane Shutters-twelve(12)openings
..r
CONSTRUCTION,iNFORMATION
Additional work to be ertormed under this permit—check all that apply:
HVAC Gas Tank fGas Piping ./. Shutters fl Windows/Doors
EIElectric ❑Plumbing U Sprinklers LI Generator _Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 53 63. 0\ Utilities: Sewer El Septic Building Height:
OWNER/LESSEE:-R/LESSEE:- , , CONTRACTOR: -.
Name Richard F Denmon Name: Miriam Van Tassel
Address:128 Blue Grotto Drive Company: DVT Hurricane Shutters, Inc.
City: Fort Pierce State:FL Address: 3100 N Kings Highway
Zip Code: 34945 Fax: City: Fort Pierce State:FL
Phone No.270-929-4887 Zip Code: 34951 Fax: 772-794-1590
E-Mail: jerryanna@hotmail.com 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: Richard F Denmon Name:Miriam Van Tassel
Address:128 Blue Grotto Drive,Fort Pierce,FL 34945 Address: 128 Blue Grotto Drive
City: Fort Pierce State: City: Fort Pierce State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:3100 N Kings Highway 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.
fil
\ c,-,.._c----''Vr.7--AJSignaturef Owner/Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,20_ by this day of ,20_ by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED _
Rev.8/2/17