HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED G
Date: d ) -7- ( k Permit Number: �o ��®31 Jy�
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Building Permit Application pest/ c9�Q� 7e
and Code Regulation Division Planning and Development Services /eporr
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Building
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Window/door
PROPOSED1MPROVEMENT LOCATION:
Address: 6036 Travelers Way, Ft Pierce, Fl 34982
Legal Description: Palm Grove S/D Blk D Lot 4(0.12 AC)(0R4013-1080)
Property Tax ID#: 3410-503-0100-000-3 Lot No.4
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Installing an impact rated sliding glass door on the back of the home.
CONSTRUCTION INFORMATION
Additional work
to be pe Gas Tank under this Gas Pi incheck all�_Shutters Windows/Doors p apply:
n p g na
I I Electric D Plumbing SprinklersIll Generator I I Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Fnloor:
Cost of Construction:$ 8200.00 Utilities:Sewer' 1 Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name Richard &Cheryl Sullivan Name: Jeff Jackman
Address:1118 North Water StCompany: Master Craft Aluminum Products
City: New London State: Address: 1634 SE Niemeyer Cir
Zip Code: 54961-1030 Fax: City: Port St Lucie State:FL
Phone No.920-841-4433 Zip Code: 34952 Fax: 772-335-0860
E-Mail: 1 Phone No. 772-335-1177
Fill in fee simple Title Holder on next page(if different E-Mail: mastercraftaluminum@gmail.com
from the Owner listed above) State or County License: SCC131150586
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:Richard 8 Cheryl Sullivan j Name:Jeff Jackman
Address:6036 Travelers Way,Ft Pierce,Fl 34982 Address: 1118 North Water St
City: New London State: City: Port St Lucie State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: 1634 SE Niemeyer Cir 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.
J.�
Sign. �w er/Le.see/Contractor as Agent for Owner Si •n ractar/License Holder
S 0 LORIDA STATE OF FLORIDA
COUNTY OF St Lucie COUNTY OF St Lucie
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
.,G,�
this /7 day of geAxA,, ,20 /8 by this (/ day of OA.-61-4, ,20/1 by
le(- lip,44„,,, UPPP d'el -F----
Name of persgn making statement Name of person making statement
Personally Known X OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary public-State of Florida ) (Signature of Notary Public-State of Florida)
Commission No. Sheryl D( Commission r. Sheryl D.Moore (Seal)
s ,.43'-f. NOTARY PUBLIC ,':,,` ,.( NOTARY PUBLIC
f'f STATE OF FLORIDA
t ,y, :.STATE OF
FLORID
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nlreB1REVIEWS FRO.' SUPERVISOR PLANS '. ' AT SEA- RTL
E MANGROVE
COUNTER REVIEW NV151SE
REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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