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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE A CEPTED i Date: I R I Per it Number: I ° ©l�� _�- - z. ...�..�. Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 X Phone:(772)462-1553 Fax:(772)462-1578 Commercial T_ Residential PERMIT APPLICATION FOR: To Select from dropbox, click rrow at the end of line .PROPOSEQ IMPROVEMENT LOCATION: Address: 9416 PORTSIDE DRIVE, FORT PIERCE, FL 34945 Legal Description: PALM BREEZES CLUB (PB 49-32)BL K 3 LOT 5 (OR 3645-1046) Property Tax ID#: 2310-500-0073-000-5 Lot No. 5 Site Plan Name: DAISY DUBOSE Block No. 3 Project Name: DAISY DUBOSE Setbacks Front Back: Right Side: eft Side: D,ETA°ILEDDESCRIPTION'OF WORK: - INSTALLATION OF HURRICANE SHUTTERS-ONE(1)OPENING (:CONSTRUCTION INFORMATION: Additional work to be nerrormed under this permit—check all ap y: ❑HVAC Gas Tank ❑Gas Piping S utters ❑Windows/Doors ❑Electric ❑Plumbing '❑Sprinklers ❑G nerator ❑Roof Roof pitch Total Sq.Ft of Construction: S Ftof irst Floor: Cost of Construction:$ $56.1.75 Utilities. Se er El Septic Building Height: OWNER%LESSEE: CONT ACTOR: Name DAISY L DUBOSE Name: I MIRIAM VAN TASSEL Address: 9416 PORTSIDE DRIVE Compan DVT HURRICANE SHUTTERS, INC City: FORT PIERCE State:FL Address 3100 N KINGS HIGHWAY Zip Code: 34945 Fax: City: ORT PIERCE State:FL Phone No. 301-861-6980 Zip Cod 34951 Fax: 772-794-1590 E-Mail: dubosedl2000@gmaii.com Phone o. 772-794-1581 Fill in fee simple Title Holder on next page(if different E-Mail: vthurricaneshuttersinc@hotmail.com from the Owner listed above) State or County License: 24394 If value of construction is$2500 or more,a RECORDED Notice of Commenc ment is required. I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORIVIATIO DESIGNER/ENGINEER: _Not Applicable MORTGAGCOMPANY: _Not Applicable Name: DAISY!_DUBOSE Name: MIR VANTASSEL Address: 9416 PORTSIDE DRIVE,FORT PIERCE,FL 34M Address: 16 PORTSIDE DRIVE City: FORT PIERCE State: City: FORT OIERCE State: Zip: Phone Zip: Phone: FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING�OMPANY: Not Applicable Name: Name: Address: 3100 N KINGS HIGHWAY Address: City: City: Zip: Phone: Zip: Phone: I OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain al permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a prmit. 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 o 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 bounty 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 f Owner/Lessee/Contractor as Agent for Owner Signature o Cr tractor/License Holder STATE OF FLORIDAc:z-_p ` STATE 0 Fl FLORID l COUNTY OF �C•1�A4 ) COUNTY F � 11U �i4 � T forgoing ins um nt was acknowled a before me ThA rgoin ins me t was acknowledge before me thl3 day of 20by thi d y of 20 by Name of�er�on making statement N me of person making statement Personally Known OR Produced Identification Personally now OR Produced Identification Type of Identification Type of Id ntification Produced Produced I I ( ' atOe of Notary Public-State of orida) (Signature of kotary Public-State of Florkla) Commission No. eal) mmissi In No. v, (Seal) �Pa > , LASHAHNA INGRAM `�s Notary Public-State of Flori a I ;I"P�"°uo��; LASHAHNA INGRAM a Notav h o, . Commission#`FFy1777q� V� =N°v ¢ My Comm.Expires D? 9n n ua �1fIANGtOVE01�i REVIEWS FROM � NIN,Cadr:d tr oSUFERVISOR;.,, PLANS VEGETATI °r� �'URTh5rnis�i COUNTER' 'REVIEW-z REVIEW REVIEW REVIEW 12 VIEWed throu ih N�E�IEW a� .. DATE - - RECEIVED DATE COMPLETED Rev.8/2/17