HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: Permit Number:
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: Window/door
PROPOSED IMPROVEMENT LOCATION:
Address:AM I 11::� Oclpacl\�C 2
Legal Description: UJR L\Qa = q___NJ
_-11
Property Tax ID#Y dSN_!U)— r� n cl --7(� Lot No.
Site Plan Name: 1 Q(1 lv` �la Y --t-e,( Block No.
Project Name: Y1G�\2( t� 1 '�g(!0\Y�1�0 f
Setbacks Front Back: 2 Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
REPLACE �J WINDOWS & DOORS WITH IMPACT. SIZE FOR SIZE.
CONSTRUCTION INFORMATION
Additionalworkto e e orme under is perm—It---c—fie—c all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers FIGenerator g Roof Roof pitch
Total Sq. Ft of Construction: c� S . Ft.of First Floor:
Cost of Construction:$ i� Utilities:11 Sewer F]Septic Building Height:
O.WNERAESSEE: CONTRACTOR:
Name 'i"( Name: WAYNE THOMAS BURNETT y
Address: Company: FLORIDA HOME IMPROVEMENT ASSOC.
City c\ _ State:FL Address: 3044 SW 42ND STREET
Zip Code: JI Fax: City: HOLLYWOOD State:FL
Phone No.!5;(�- ��c11�10 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: . ,
DESIGNER/ENGINEER: XX Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: i 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
commencinR work or recording our Notice of Commencement.
S
S' nature of Owner/Lessee/Contractor as Agent for Owner Sit
re f n License Holder
STATE OF FLORIDA STA EA
COUNTY OF 6A.( 3T LQC is COU OF
The forgoing instrument was acknowledged before me The f going instrumnt was acknowledged before me
this�`✓fday of Nas£tt'a£c1 20 lby this day of eC 20 by
1 WAYNE THOMAS BURNETT
(Name of per =acknog) (Name of person ackno dging)
(Signature of Notary Public-State of Florida) (Si ature N ary Public-State of Florida)
Personally Known OR Produced Identification Perso all nown OR Produced Identification
Type of Identification Produced Ty
p o dentificati Produced
Y°La N99tary Public State of Florida
Commission No. �°. �� Ftp A ico M Almeida ommission No.
My Commission GG 139459 ;,�it�aUEL.A ADO
Expires 08129/2021 �'; •'? MY COMMISSION#!GG095745
'•.,,p,�� EXPIRES April 19,2021
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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