HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �(
Date: Permit Number: �' U
_ = RECEIVED
Building Permit Application MAY 2 5 2018
Planning and Development Services LST. I"ui�(:aunty, Permitting
Building and Code Regulation Division _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
r
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 6794 SINSONTE COURT, FORT PIERCE, FL 34951
Legal Description: 06 34 39 THAT PART OF SEC AS SHOWN IN OR 2380-1934 BEING LOT 6794 SINSONTE
(BLK 65 LOT 17) (0.13 AC - 5,663 SF) (OR 4103-1776)
Property Tax ID#: 1306-501-0878-000-5 Lot No. 17
Site Plan Name: SKOWRONEK RESIDENCE Block No. 65
Project Name: SKOWRONEK RESIDENCE
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
INSTALLATION OF HURRICANE SHUTTERS - NINE(9)OPENINGS
CONSTRUCTION INFORMATION:
Additional work to be performed under t rspermit—check all that appy:
HVAC Gas Tank ❑Gas Piping ✓ Shutters Windows/Doors
❑Electric ❑ Plumbing Sprinklers ❑Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 6,243.42 Utilities: Sewer C Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ANDREA SKOWRONEK Name: MIRIAM VAN TASSEL
Address: 6794 SINSONTE COURT Company: DVT HURRICANE SHUTTERS, INC.
City: FORT PIERCE State: FIL Address: 3100 N KINGS HIGHWAY
Zip Code: 34951 Fax: City: FORT PIERCE State: FL
Phone No. 410-474-7156 Zip Code: 34951 Fax: 772-794-1590
E-Mail: arskowronek@yahoo.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: ANDREA SKOWRONEK Name: MIR"VAN TASSEL
Address: 6794 SINSONTE COURT,FORT PIERCE,FL 34951 Address: 6794 SINSONTE COURT
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 our Notice of Commencement.
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Signature of 1caner/Lessee/Contractor as Agent for Owner Signature of ntractor/License Holder
STATE OF FLORIDv L.I STATE OF FLORIDA Lu COUNTY OF ... LE . COUNTY OF
The forgoing instrument was acknowledgeobefore me The forgoing instru ent was acknowledge¢.pefore me
thi day of M)&' 20 IX by this day of PO4
20 by
Name of person aking statement Name of persot making statement
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signat 00'.0- PuKYi o J&Ii&�N (Signature of Ir-c a f Florida)
;aQ -State of Florida Notary ublic
419 KAREN S. 1 �,$EN
Commiss q a Commission # GG ``�4 ,``Pp•��B',, E�'{
My scion E �A§ I Commission N =:°' f Florida Public
Juna 12_2022f P`c Commission # GG 207464
-,Fo„,•; My Corr.m:ssion Expir'3s
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17