HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 08/29/2018 Permit Number:
r: _
WOW RECEIVED
Building Permit Application
Planning and Development Services SEP 14 2018
Building and Code Regulation Division
ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: w9wAj= �
PROPOSED IM'PROVEMENT'LOCATION.
Address: X,4A&Aj A. Ad&jAu(l' -36PA-ykd -`S 4,61 3 q 194
Legal Description: Palm Grove S/D BLK J LOT 5(0.13AC)(OR 1137-887)
Property Tax ID#: 3410-503-0257-000-8 Lot No.5
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace 9 x 7 Garage Door Size for Size
CONSTRUCTION INFORMATION:
Additional work to be nerformed under tispermit—check all appy:
HVAC Gas Tank OGas Piping _Shutters a Windows/Doors
Electric Plumbing OSprinklers O Generator O Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 1,683.00 Utilities:Sewer OSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ,jZ Name:
Address: Company: Quality Garage Door Services
City: T;A[ti State: Fl. Address: 116 S . j414&
Zip Code: 34982 Fax: City: �' 7D.5 J,'// State:FI
Phone No.772-293-9935 Zip Code: 32796 Fax: 321-264-7416
E-Mail: Phone No. 321-264-6399
Fill in fee simple Title Holder on next page(if different E-Mail: qualitygaragedoorservices@yahoo.com
from the Owner listed above) State or County License: CRC1329903
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: _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[.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 inspecti ou i nd to obtain financing, consult with I rider or an attorney before
commencin work In r Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA4 STATE OF FLA, DA
COUNTY OF COUNTY OF
The or oing instrL# ent as acknowledg efore me The forgoing instrument was acknowledg d efore me
this day of 20by this�•bday ofk 20�by
� ll,__��P , Yy1i�c \ O
Name of person making statement , / Name of er on making statement
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identif' 'on Type of Identification
Produced Produced
AA
(Signature of Nota - (S gnature of Notary
pa KAREN I E LS E N Notary Public St®te of Florida
Commission No. :01�YPGBG�4 Dl rle Lisa A S*631�n
e of FI �J0tary Public Commission No
=* *= Commission # GG 207484 MyCommisaionGG212244
My Commission Expir'as Expires 08124/20"m
'ii��``�� June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17