HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q 239
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Date: O Permit Number: /U 62-0 /3 9
FRECIEVED
Building Permit Application 7 2o1s
Planning and Development ServicesBuilding and Code Regulation Division nty, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
.Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Window/door
PROPOSED:IMPROVEMENT LOCATION:
Address: 5003 Indian Bend LN Fort Pierce, FL 34951
Legal Description: HOLIDAY PINES S/D-PHASE II-A-LOT 185 (MAP 13/13N) (OR 1101-474)
Property Tax ID#: 1312-800-0016-000-2 Lot No.185
Site Plan Name: Block No.
Project Name: William L Alvey
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace 10 Windows W/Impact, Size for size.
C=�. �� ��11 CZ2. •
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit–c ec a appy:
11HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers ElGenerator E]Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 11,605 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name William L Alvey Name: WAYNE T. BURNETT
Address:5003 Indian Bend LN Company: FLORIDA HOME IMPROVEMENT ASSOC
City: Fort Pierce, State: FL Address: 3044 SW 42 St.
Zip Code: 34951 Fax: City: HOLLYWOOD State:FL
Phone No. Z ^N:�V-3 _!s�-� Zip Code: 33312 Fax: 407-4728380
E-Mail: Phone No. 954-7924415
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: r 6 C-0c" l89 cp
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
UPPLEi�AENT/AI.;CONSTRUC170N LIEN Le4V1l OI OR�r9A1ION:
DESIGNERANGINEER: _Not Applicable MORTGAGE COMPANY: _N t Applicable
Name:W®amLAhW Name:wAYNET BU
Address:sm mit ee ri X Address: 3044 SW St-
City: Fod Pierce, State: fl City: HOLLYWOOD I State: FL
Zip: 34951 hon — S� Zip: 33312 Ph e: c
FEE SIMPLE ThU HOLDER: Not Applicable BONDING COMPANY: —Not Applicable
Name: Naive:
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 an Y applicable Home Owners Association rules,bylaws or and covenants that may restrict or pro i it 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 Cortes 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 Comme cermnt.
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Signatur ver/ ee/Con as Ag fo Owner Sign �QDor/License
Holder
STATE OF FLORI®A STATE A
COUNTY OE <,A-. <<)c c e COUNTY OF SCA L IL7 c
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day of i .20-Wby this,lI day of '�„1p� .20_ff by
I. ,i Cit o..,. OW co _ k,024"
CQ�I
Name of person a ' g statement N me of person malting statement
Personally Known OR Produced identification Personally Known�OR Produced Identification
Type of identification 9 O Type of Identification
Produced `G o\ Produced
\
r
atur Notary Public-State ofVier� g re of Notary Public-State of Florida
Commission No. �� Commission No.
{QUDUp� V�
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REVIEWS FROVT ZONING SUPERVISOR. PLANS VEGETATION s16TURTLE MANGROVE
COUNIMO" REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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