HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN D MUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: m Permit Number: N 01-010 5
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Building Permit Application
Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982ST
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential XXXX
PERMIT APPLICATION FOR: Shutterl4V,,�cJ
PROPOSED INIPROVEMENi"=LOCATION
Address: 5504 Palm Drive Fort Piercce, FI 34982
Legal Description:
Property Tax ID#: 3402-609-0148-000-1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
'Q
DET WORK.. _
replace the 3 front windows on the house and addind 4 new shutters on the front.
cbNSTRU'C-T6 INFORMATION
Additional work to be nerformed under this permit—check all that apply:
HVAC Gas Tank ❑Gas Piping ✓ Shutters ✓Q Windows/Doors
ElElectric 0 Plumbing Sprinklers ElGenerator EIRoof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 500.00 Utilities: SewerSeptic Building Height:
OVI(NER%LESSEE CONTRACTOR:;'
NameJennifer Sloan Name:
Address:5504 Palm Dr Company:
City: Fort Pierce State: FI Address:
Zip Code: 34982 Fax: City: State:
Phone No.772-370-0995 Zip Code: Fax:
E-Mai1:randj02@aol.com Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION�LIEN LAW IIVFORIVIATION.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable'
N a m e:Jennifer Sloan Name:
Address:5504 Palm Drive Fort Pierce,FI 34982 Address: 5504 Palm Dr
City: Fort Pierce 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
commenc• ork or Lecordipg your Notice of Commencement.
Signature of wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S� . COUNTY OF
The forgoing instrument was acknowledgebefore me The forgoing instrument was acknowledged before me
'
this day of 0% :�9 20_ by this day of .20_ by
�C e,\4�A4'N
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced �' L �-^ Produced
(Signature of Notary Pub'c-State of F�or�da�L - —�- (Signature of Notary Public-State of Florida)
��-NAMAR E GIVENS b
Commission N :4`+'�- �Mlssto b992023 Commission No. (Seal)
* e` EXPIRES:December 16,2020
BonPublic Underwriters
••,FocF;°•
Bonded
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17