HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:. Q l� Permit Number: NC9
RECEIVEDT
Building Permit Application SEP 17 2018
Planning and Development Services
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: Window/door
PROPOSED IM'PROVEMENT.LOCAT QN
,
Address: 1102 ISI . Lam CSI aZKNye L'n ►�t- t,. t'[ 3y9S:)
Legal Description:_gamma Imo— 1 �� F Is,ri u - Se:g_-};vt (,),,n e
Property Tax ID#:L1 r-) - cp i to - cmc c-� - 1 Lot No.
Site Plan Name: Block No.
Project Name:5'Se.C 1, lig LLC_
Setbacks Front_ Back:_ Right Side: Left Side:_
DETAILED DESCRIPTION O'F:WOR K � s
REPLACE ^1 WINDOWS & yS DOORS WITH IMPACT. SIZE FOR'SIZE.
CON
STRUCTI(0N INFORMATION
y .,
Additional
work=toe e orme under this permit-check a that apply:
IIHVAC 11 Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing []Sprinklers 1:1 Generator E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
1 �U, >
Cost of Construction:$ ! Utilities: Sewer Septic Building Height:
OWNER/LESSEE tiCONTRACTOR
Name_Ifn a moi„ le c- P, Fre NI,,-9 r- Name: WAYNE THOMAS BURNETT
Address:3'3'-I I E C--(p 'S:>r)v c-- Company: FLORIDA HOME IMPROVEMENT ASSOC.
City: .T-1-- State:FL Address: 3044 SW 42ND STREET
Zip Code: 31-19 9-1 Fax: City: HOLLYWOOD State:FL
Phone No. S'Lp I- 9'7'1 c3 Zip Code: 33312 Fax:
E-Mail: Phone No. 954-792-4415
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: CGC#061890
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:' ,
., _.e . �r< . �, .. . .. .
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: x Not Applicable .
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commen e
S
Signature of Owner/Lessee/Contractor as gent for Owner S ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF e,+ Lvcs COUNTY OF 4"1A .LuGte.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Sff4n rC y_.. 20 i$ by this LA day of�1W 20 BL_by
Vy �G.��♦ m• `� �Q'��a/t.�I',I WAYNE THOMAS BURNM
(Name of person dging) (Name of person ckno ledging)
(Signature of NotaAZOR
tate of Florida) (Sign re taryPublic- tate of Florida)
Personally Known Produced Identification PerKaall nown ORProduced Identification
Type of Identification Produced Typntification Produced
Commission No. ray NotaryPu�bt teofFlorida Commission N :�s�Pu• ��A
i Francisco M Almeida +. ,.: DO
Up * My Commission GG 139459 y�_ .'t iNY COIUi1RISSiON#GG09374,9
r 0812912021
oFn a or v April 19,2021
Revised 07/15/2
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