HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:at�' - ou%(0 __
_ _ RECEIVED
Building Permit Applicatio , MAY 2 5 2018
Planning and Development Services ST, Lwrie County P+srmitting
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
PROPOSED IMPROVEMENT LOCATION:
Address: 6311 Green Dolphin Street, Fort Pierce, FL 34951
Legal Description. LAKEWOOD PARK-UNIT 6- BLK 69 LOT13 (MAP 13/02S)
(OR 1033-1292: 1081-2115 : 2328-658)
Property Tax ID#. 1301-606-0269-000-0 Lot No. 13
Site Plan Name: Jane Voyta-Petersen Block No. 69
Project Name: Jane Voyta-Petersen
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Installation of hurricane shutters(two(2)openings)
R e wo v-I< N:Ke�Q� � �K.i ��S P� �c �5��►�SlA-�-e�5
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit-check aMI/
apply:
HVAC E]Gas Tank Gas Piping Shutters Q Windows/Doors
11 Electric ❑ Plumbing Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 2319.74 Utilities: Sewer FISeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameJane Voyta-Petersen Name: Miriam Van Tassel
Address:6311 Green Dolphin Street Company: DVT Hurricane Shutters, Inc.
City: Fort Pierce State:FL Address: 3100 N Kings Hwy
Zip Code: 34951 Fax: City: Fort Pierce State, FL
Phone No.978-821-8542 Zip Code: 34951 Fax: 772-794-1590
E-Mail:janev15@gmail.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: 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 1 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'Owner/Lessee/Contractor as Agent for Owner Signaturd of ntractor/License Holder
STATE OF FLORIDAq I Ll STATE OF FLORIDA
COUNTY OF ,�1 f C I COUNTY OF
The forgoing instrument was acknowledge before me The fkrgoing instrument was acknowledge efore me
this day of y��� 0by this day of 11/1 P--, 20-V by
-moi r 1H tri
Name of person f aking statement Name of per n making statement
Personally Known ✓ OR Produced Identification Personally Known 7 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 Nc _ Commission No. (Seal)
PqY MVa,, KAREN S. NICI.SEN
::.State of Florida-Notary (uhlic
pgyP/,
Commission k GG 2 7,tA4 C. KAR
,rF•,t,_n M Commission I xpiras ="- C of F101;LL
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REVIEWS iYL:,27 0 �$ SOR PLANS VEGET IC�AP;,;;°A�E 'I on COUNTER ��
REVIEW REVI EVI "'n s; �n i
DATE �2
RECEIVED
DATE
COMPLETED
Rev.8/2/17