HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_ �`� Permit Number:
`s RECEIVED
0
Building Permit Application APR ® 9 ?019
Planning and Development Services x, ST. Lucie Count
Building and Code Regulation Division y, Pe,rnitting
2300 Virginia Avenue,Fort Pierce FL 34982 "
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Window/door
RRQP.OSED I.IVIPROVEKA NT LOCATION
Address: 73 S LAS OLAS DR
Legal Description: BEACH CLUB COLONY-SECTION ONE W 52.03 FT OF LOT 25(OR 626-2200: 3734-2182,2184;3746-981)
Property Tax ID#: 4511-500-0051-000-8 Lot No.
Site Plan Name: Block No.
Project Name: Geertsema 996
Setbacks Front Back: Right Side: Left,Side:
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D'fTAILED DESCRIPTIOUOF WORK.'
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Window/door replacement size for,size -3 l.0, 11 Nl l
CONSTRUCTION INfORM' ION n
Additional work to be performed un er t ispermit—check all. app,.y
x . ,x .9
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HVAC",:, Gas Tank Gas Piping ', .Shu't#ers Q Windows/Doors
;Electric 0 Plumbing Sprinklers ~'Ehenerator Roof
Total>Sq. Ft-of Construction: S . Ft. of First Floor:
Cost of Construction:$ 5325.00 Utilities: Sewer Septic Building Height:
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OWN°ER/LESSEE NTR'ACTOR `
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Name Bruce K Geertsema Name: Mark Collins
Address:73 S Las Olas Dr Company: Window..World of West Palm Beach
City: Jensen Beach State:FL Address: 1500 N. Florida Mango Road, Suite 16B
Zip Code: 34957 Fax: City: West Palm Beach State.FL
Phone No. Zip Code: 33409 Fax: (561)684-2050
E-Mail: Phone No. (561)684-2040
Fill in fee simple Title Holder on next page(if different E-Mail: westpalmbeach@windowworld.com
from the Owner listed above) State or County License: CBC1260052
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN,LA\klNFORMATION ,
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DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: 7 x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable F: 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 0 NER:Your failure to Record a Notice of Commencement y It in your paying twice for
improvemen ur rope o ice of Commencement must be d and poste jobsite
before the spectio you inte da'ning,:consul I er or orney be re
\cornme or or r ordi ou o "Mfen'ceffient.
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Ignature of Owner/Lessee/Agent Z o Signa re of Contractor/License Holder V5 05 to
STATE OF FLORIDA a STATE OF FLORIDA N is
COUNTY OF Palm Beach - n COUNTY OF Palm Basch w �
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The for oing instru ent wa acknowledged befo me;,l` The forgoing instrument was cknowledged befor w r
this day of 20by '�'= this day of , _20 by V Z
' c' o u']
Mark Collins'& cf K t Mark Collins _
(Name of person knowledging) s ' (Name of person acknowledging) '; '•*''o%d•;
(Signatur f riditary Public-State of Florida) '_,o (Sig re of Notary Public-State of Flori a C
Personally Known x OR Produced Identifies\o�i�h Personally Known x OR Produced I entfficatioo',
Type of Identification Produced Type of Identification Produced „
Commission No. (Seal) Commission No. "`-
V o;
Revised 07/15/2014
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