HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� 1 (� Permit Number: Yn�) n1v
RECEIVED
Building Permit Application AUG 21 209$
Planning and Development Services
Building and Code Regulation Division ST, W91e Spunty,_Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Shutter
PROPOSED.IIVIP,RO.VEM_E,NT.LOCATLON .:
Address: 122 QUEEN ANN COURT, FORT PIERCE, FL 34949
Legal Description: QUEENS COVE-UNIT 1-BLK 20 LOT F (OR 227-7258; 2479-1889: 3902-2878
Property Tax ID#: 1414-701-0200-000-8 Lot No. F
Site Plan Name: DEBOLT Block No. 20
Project Name: DEBOLT
Setbacks Front X Back: X Right Side: Left Side: X
DETAILED DESCRIPTIOKOF WORK ",-:
INSTALLATION OF(10)ACCORDION HURRICANE SHUTTERS
s
CONSTRUCTION 1'NFORMATION
✓
Additional work to e e orme under this permit—check all apply:
HVAC GasTank F]Gas Piping Shutters Q Windows/Doors
11 Electric ❑Plumbing Sprinklers OGenerator E] Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 9064.77 UtilitieslnSewer D Septic Building Height:
OVUNEft/LESSEE . . CONTRACTOR:'
Name MARGIE DEBOLT Name: MIRIAM VAN TASSEL
Address:122 QUEEN ANN COURT Company: DVT HURRICANE SHUTTERS INC.
City: FORT PIERCE State:FL Address: 3100 N KINGS HWY
Zip Code: 34949 Fax: City: FOR_T PIERCE State:FL
Phone No.772-465-1528 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`CONSTRli TION LI' N-LAW INFORMATION.``
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 thepermit 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.
f l rl '- h AN LJ--�
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Signature of caner/Lessee/Contractor as Agent for Owner Signature�f Contractor/License Holder
STATE OF FLORIDA L STATE OF COUNTY OFORIDA S� L�
COUNTY OF S T- ��'z�
The forgoing instrument was acknowledged eforeme The forgoing instrument was acknowledged before me
this ;�-) day of 20 1 a by this day of G 20 by
N"V% vv-� I V. -
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Name of person aking statement Name of pers making statement
Personally Known\OR Produced Identification Personally Known 7 OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of Notary Public-State of Florida) ignature of Notary Public-State of Florida).
Commission No. ,,0111111 K� �N S. NIELSEN
State o lorida-Notary Publ mmission No.
_. •= Commission # GG 20748
;ZpRY PUB�� KAREN SI
My Commission Expires a° ��;State of Florid
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" �,;;oF«o�°•' C"102mi"RiAll :4 Gr 207484
My Co misREVIEWS FRONT NTNG SUPERVISOR PLANS VEGETATIO nRJIl
COUNTER REVIEW REVIEW REVIEW REVIEW Ktvltvv
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17