HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BEE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: CV .5- ( 2-6 iD Permit Number: (2' tk 0050
ONNINIWIMMEWNIMONOMI
COUNTY
FL OR ID, .A
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Shutter
PROPOSED IMPROVEMENT LOCATION
Address: 5202 INDIAN BEND LANE, FORT PIERCE, FL 34951
Legal Description: HOLIDAY PINES S/D- PHASE II-A-LOT 177 (MAP 13/12S) (OR 3935-1708)
Property Tax ID#: 1312-800-0008-000-3 Lot No. 177
Site Plan Name: CHRISTIANSON Block No.
Project Name: CHRISTIANSON
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION QF WORK
INSTALLATION OF: (14)ACCORDION SHUTTER SYS., (1)C'pbQ /Af,SHUTTER, (1)CLEAR STORM PANEL
-.CONSTRUCTION INFORMATION
Additional work to be erformed under this permit—check all-hat apply:
HVAC IGas Tank Gas Piping ✓ Shutters I I Windows/Doors
❑Electric ❑ Plumbing I-lSprinklers Generator 1-1 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 9,381.61 Utilities: _Sewer Septic Building Height:
OW N ER/LESSEE CONTRACTOR
Name JAMES R. CHRISTIANSON Name: MIRIAM VAN TASSEL
Address: 5202 INDIAN BEND LANE 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. 206-914-1481 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.
L
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
commencing work or recording your Notice of Commencement.
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I� . �C�. A— ws,JA
l�Signatur of Owner/Lessee/Contractor as Agent for Owner Signature of Co26-ar....0.
ractor/License Holder
STATE OF FLORIDA 51-_ Lixr-tia, STATE OF FLORIDA G
COUNTY OF COUNTY OF J�d
The forgoing instrume t was agkn�owledged efore me The forgoing instrument was acknowledged before me
this day of N0 ve yvos1 -,20 �K by this 5' day of J\J'
` I rwV)"',201 8 by
Name of person making statement pi_ Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification L')L_
Type of Identification Type of Identification
Produced FL— PL Produced Ft— 17 L.
' 1 d
of Not
(Signature of Notar ;•
(Signature w------rte g Y.-.:�...� .<... . ., _
ELLEN VAUGHN �arP '
„��� H N
,449/Ws.
�=otia �a�� S ELLEN V UG
Commission No. , =;�;a s.State of Flo( Notary Public Commission No. .. �;\1"= tate of FI45.304lotary.Public
Al”�a Commission #GG 270079 ?,�,i�i,o�c` omm:ssion #GG 270079
-7,t , oe�: My Commission Expires --,:tit, My Commission Expires
�,�orF��� October 22, 2022 ���"��� October 22, 2099
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17