HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A -U4 Permit Number:
I J._ t-
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Building Permit Application
RECEIVED
Planning and Development Services SEP 2 4 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 �� LV!61q Pty, Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resl --
PERMIT APPLICATION FOR: Shutter
PROPOSED IMPROVEMENT LOCATION:
Address: 4107 SMOKEY PINES COURT, FORT PIERCE, FL 34951
Legal Description:
HOLIDAY PINES S/D-PHASE 111-LOT529 (MAP 14/18N) (OR 812-1263)
Property Tax ID#: 1313-502-0106-000-8 Lot No. 529
Site Plan Name: BLAIR Block No.
Project Name: BLAIR
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
INSTALLATION OF(3)ACCORDION HURRICANE SHUTTERS.Sy,5 ;6071
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit—check a appy:
HVAC Gas Tank ❑Gas Piping �_Shutters ❑Windows/Doors
11Electric ❑ Plumbing 11Sprinklers ❑Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: t, c� S Ft. of First Floor:
Cost of Construction: $ 1 �3 �D / Utilities:Cn Sewer F]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name JOHN BLAIR Name: MIRIAM VAN TASSEL
Address: 4107 SMOKEY PINES COURT 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. 772-971-4459 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:
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
commenci ork or recording our Notice of Commencement.
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Signature of ner/Lessee/Contractor as Agent for Owner Signature of ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S� ��- COUNTY OF S J
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledgedefore me
this day off / nn / 204 by this�day of S orvi1,e/ 20L by
ly l i Cy rv9 V�rz
Name of person aking statement Name of person making statement
Personally Known rOR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Sign ture of Notary Public-St of Florida) (Signatu e of Notary Public-State of orida )
Commission No. (Seal) Commission No. (Seal)
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REVIEWS FRONT ZONING SU PLANS VEGETATION SEA TURTLE M 0O
COUNTER REVIEW om EVIEW REVIEW REVIEW
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DATE .a c Q-af*Ak CoQ
RECEIVED I°�°F 4 �o or��b�
DATEQoco`
COMPLETED `l'm �,�4
Rev. 8/2/17