HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a�° �� Permit Number:
ism � __. -_;,.- _ RECEIVED
o �
Building Permit Applicati n JUL 2 6 2018
Planning and Development Services T. Lucie County, PBP(f1ltKiii9
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: indow/door
PROPOSED-IMPROVEMENT LOCATION:,
Address: g 1 1 i a a-, C;
Legal Description: -►-r„e_ �+�e���v 'P._..rJ c_,t -1 ems. r y�P_�
Property Tax ID#: 9 Lot No. !S
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: LI Right Side: Left Side:
DETAILED DESCRIPTION OF-WORK:
REPLACE L-I WINDOWS & ,Z DOORS WITH IMPACT. SIZE FOR SIZE.
.0,0 t -1 __� *3, _a_L, l\`
CONSTRUCTION INFORMATION:
Additional work to be Dertormed under this permit—check a tat app y:
[MVAC0 Gas Tank Gas Piping _Shutters Q Windows/Doors
FlElectric F] Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction: $ I� -,;y--,c) Utilities: Sewer E]Septic Building Height:
OWNER/LESSEE: , CONTRACTOR:
Name'LA20AaQ Name: WAYNE THOMAS BURNETT-
Address:�\'�?-, 1h\.c_Ak'Cid g\ Q�k&Ck-E Company: FLORIDA HOME IMPROVEMENT ASSOC.
City:?-C-)c State:FL Address: 3044 SW 42ND STREET
Zip Code: Fax: City: HOLLYWOOD State:FL
Phone No. aI.N— q`0 Zip Code: 33312 Fax:
E-Mail: Phone No. 954-792-4415
Fill in fee simple Title Holder on next page(if different E-Mail: PERMITS@FHAPRODUCTS.COM
from the Owner listed above) State or County License: CGC#061890
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 rpcording your Notice of Commencement.
qwF��
s
Signature of Owne Lessee/Contractor as Agent for Owner Sig=OLORIDA
for/License Holder
STATE OF FLORIDA ST
COUNTY OF 5-4- l.ycG E COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledgedbeforeme
this�day of J u 20 18 l
by this q day of �OiNI 20 I O by
I �bORDo �'��6 WAYNE THOMAS BURNETT
(Name of per wl in ) (Name of person ack wledging)
(Signature of NotarOR
-State of Florida) (Signatu of Pu ic-State of Florida)
Personally Known Produced Identification Perso all own OR Produced Identificat'o_'
Type of Identificaion P Type Identificati n r . i�
_9oit;. °Gc_
o"SY°& Notary Public State of Florida
Francis ) s_ MY COMMIS$ON GG095745
Commission No. •` �Almeida Commission No. t e I
c My Commission GG 139459 =, o p o;: EXPIRES prri 49,2021
oc pd- Expires 08/29/2021
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS