HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�, ;;--11
Date: �� (� Permit Num IR `� V4
9)
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Building Permit Applicatio AUG 1 7 2018
Planning and Development Services Permitting Department
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St, Lucie County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR: Shutter
.PRO POSED,IMPROVEMENT LOCATION,.
Address: 6654 GAVIOTA CT., FORT PIERCE, FL 34951
Legal Description: SPANISH LAKES FAIRWAYS BLK41 LOT 33 (OR 4058-1)
Property Tax ID#: 1306-500-0135-000-2 Lot No. 33
Site Plan Name: CHURCH Block No. 41
Project Name: CHURCH
Setbacks FrontX Back: X Right Side: X Left Side: X
:DETAILED DESCRIPTION,OF WORK y
INSTALLATION OF 7 ACCORDION HURRICANE SHUTTERS
e
'CONSTRUCTION INFORMATION
Additional work toe e orme under this permit—check a apply:
❑HVAC E]Gas Tank []Gas Piping Shutters a Windows/Doors
❑Electric ❑Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 5561.66 Utilities: Sewer❑Septic Building Height:
QWNER% t SEE CONTRACTOR
Name DOUGLAS CHURCH Name: MIRIAM VAN TASSEL
Address:6654 GAVIOTA CT 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. Zip Code: 34951 Fax: 772-794-1590
E-Mail: 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
u u .
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 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 wrier/Lessee/Contractor as Agent for Owner Signature of C/
ntractor/License Holder
STATE OF FLORIDA ` STATE OF FLORIDA
COUNTY OF - LtJ--cR COUNTY OF GD^
The forgoing instrument was aCknowledge�efore me The forgoing instru ent was a knowledged before me
this�day of 20 by this�day of
w 20 f3 by 1
M�Ti �v✓I V�, ��a�SE'/ I" I i
Name of person making statement Name of person making statement
Personally Known a—OR Produced Identifica Personally Known ✓OR Produced Identification
Type of Identification Nom, Type of Identification
Produced tiN Produced N
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7ZR d SLL��
a LL .Y
d(Signature of No Public-State of Flo da) ooa (Signature of Not r Public-Sta e o Florida) m 55M
Commission No. (Seal) ommission No. (Seal) ¢0¢ a
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REVIEWS FRONT ZONING SUPER r,'�. ANS VEGETATION SEATURTLE MA
COUNTER REVIEW REVIE REVIEW REVIEW REVIEW R �yit
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17