HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �--�
Date: _ Permit Number: f1J
u �� RECE
Building Permit Application
Planning and Development Services MAR 19:2
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie Coumitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resi en Ia
PERMIT APPLICATION FOR: Window/door
PRQPOSED IMPROVEMtNT LOCAI`I N:
Address: 12741 Refuge LN Jensen Beach, FL 34957
Legal Description: EDEN'S REFUGE LOT 3
Property Tax ID#: 4504-702-0004-000-2 Lot No.3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAIIED.DESCRII�TtON OF INORK.� =
REPLACEMENT OF 3 WINDOWS AND 3 DOORS (IMPACT)
CONSTRUCTION INFORIVATIOt • '`
Additional work toa er orme un er t is permit—check a appy:
❑HVAC �_Gas Tank Gas Piping Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 24,500 Utilities:Cn Sewer Septic Building Height:
OWNER/LESSEE: 0b, RA
Name James/Shannon Collins Name: Alphonse Campanelli
Address:12741 Refuge LN Company: STORM TIGHT WINDOWS
City: Jensen Beach State: FL Address: 500 SW 12TH AVENUE
Zip Code: 34957 Fax: City: DEERFIELD BEACH State:FL
Phone No.(863)370-8902 Zip Code: 33442 Fax: 754-227-7891
E-Mail: u 0-c Uyn Phone No. 954-320-7554
Fill in fee simple Title Hol er on next page(if different E-Mail: stormtightpermits@outlook.com
from the Owner listed above) State or County License: CRC046091
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTA[ CONSTRUCTION.LIFN tA1tV I,NFO.RMATI;ON
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: i
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 our Notice of Commencement.
!��S&Oxl�-e!2K r 2eyd" �
Sig re of Owner/Less ee/corttractor as Agent for Owner Signature of Contractor/License Ho der
STATE OF FLQ,,RIDA e STATE OF FLORIDA
COUNTY 0FDrOtu,)_r COUNTY OFGroL06LrrJ
The forgoing instru�mment was acknowledged before me The forgoing instryyL��ent was acknowledged before before me
this_day of r_c_z 20� by this 620 day of 6t.{-J 20Q by
Ihim n anCe l I r n s 14l 1140 w C e C 9Jq d°*.ye,11
Name of person making statement Name of perso aking statement
Personally Known OR Produced Identification I-/ Personally Known OR Produced Identification
Type of Iden ification Type of Identification
PProduced
apt J�`
(Sig id° Jqa) (Signature f,1lj' ublic-fig a
ommission#GG 207 =r° ': Notary Public State of Florida
oCOm ISSiOR d om iir pr,1eal) -COmmIs510 t�T•b � ���GG 2072��ea
res Apr 15, 022
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17