HomeMy WebLinkAboutCompleted Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:5-3f1 a 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 Residential
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION:
Address: 85 Queens Road, Hutchinson Island, FL 34949
Legal Description.. QUEENS COVE-UNIT THREE- BLK 25 LOT 20 (OR 2199-1942)
Property Tax ID#: 1423-602-0020-000-6 Lot No.20
Site Plan Name: Block No. 25
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove and replace (1) 16' X 7' & (1) 8' X 7' overhead sectional garage doors.
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit—check a apply:
E1HVAC Ei Gas Tank Gas Piping rl Shutters Q Windows/Doors
11 Electric ❑ Plumbing Sprinklers E Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction: $ 2,487.00 Utilitiescn Sewer Septic Building Height:
OWNER/LESSEE: = CONTRACTOR:
Name Keith&Kimberly O'Brien Name: Kevin R. Matyjaszek
Address:85 Queens Road Company: Excelsior Construction &Roofing
City: Hutchinson Island State:FL Address: 1882 SE Crowberry Drive
Zip Code: 34949 Fax: City: Port St. Lucie State:FL
Phone No.561-239-5651 Zip Code: 34983 Fax: 772-618-6660
E-Mail: Phone No. 772-418-8809
Fill in fee simple Title Holder on next page(if different E-Mail: info@excelsiorconstruction.net
from the Owner listed above) State or County License: CGC1521911
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: V 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 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 Owner see/ ntractor as Agent for Owner Signature of Contractor tcense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .091, Ze c,e COUNTY OF _:5 . l icC.e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this -"day of &V 20j2 by this 309 day of M ,20 j/
1 by
Name of person maki statement Name of person makin statement
Personally Known t/ OR Produced Identification Personally Known ," OR Produced Identification
Type of Identification Type of Identification
Produced Produced
uL�A i
(Signature of Notary Pu ' -State of Florida) (Signature of Notary Public-Sta e f Florida)
(_,,�t^ FRANCESu.JOANS a".. FRANCESV.JO
Commission No`°�.J o �)&J< �" *aIUyCOMMISSION#GG03 3�ommission NoL. I� iC (� g I)1tyCOMM1SSI0N G6 3 3B
\Qe EXPIRES:Ocbber29,20 �� We EXPIRES:OcloberZ9,2
�`Of F4�Q Bonded TNu budget Notary Servi s Epp p%OF Bonder Ttutl Budget Nobly
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17