HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: r� Lz 7 • �a
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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.IPfUIPR01/EMENT,LOCATION �S
Address: 3126 Old Edwards RD Fort Pierce, FL 34981
Legal Description: 293540 FROM NE COR OF SW I/4 OF NW1/4CFNE 114 RUNS W OEG17 MIN 20 SEC W262,W FT FOR F09,TH CONTS00 DEG 17 MIN 20 SEC W397.6Fr.TH S88 DEG 52 MIN 20 SEC W59.63"TO NELYR NSLWMD,TH NWLYALGE
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Property Tax ID#: 2429-123-0001-300-1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
QETAILEI DSCRII?TION OF WORK' ` ¢9}
;
REPLACEMENT OF 1 DOOR (IMPACT)
,.NA mb:rj s �a °e�"$° :..v
CONSTRUCTION INFORMATION ^ ut h
Additional work to a er orme under t is permit—check a —apply:
❑HVAC El Gas Tank Gas Piping _Shutters 12"Windows/Doors
Electric ❑ Plumbing Sprinklers Generator F] Roof Roof pitch
Total Sq. Ft of Construction:,- S . Ft.of First Floor:
Cost of Construction:$ N 000-00 Utilities: Sewer F]Septic Building Height:
QWNER�LESSEE CONTRACTOR
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Name Lance P Mills i ronya R Mills - Name: Alphonse Campanelli
Address:3126 Old Edwards RD Company: STORM TIGHT WINDOWS
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City: FORT PIERCE State: FL Address: 500 SW 12TH AVENUE
Zip Code: 34981 Fax: City: DEERFIELD BEACH State:FL
Phone No.(772)418-6723 Zip Code: 33442 Fax: 754-227-7891
E-Mail: • Phone No. 954-320-7554
Fill in fee simple Title Holder 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.
iS�jUPPU MEI TAL CONSI RUCTION IIEN LAWkIl FQFtMAT10�1
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:Alphonse Campanelll
Address: Address:
City: State: City: DEERFIELD BEACH State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:500 SW 12TH AVENUE 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 recordi_pg your Notice of Commencement.
11flA AA
Sign t reOwner/Lessee/Con racto as Agent for Owner Signature of Contractor/License Holder
STATE OF FL IDA STATE OF FLO IDA
COUNTY OF r6Lx.3c,_o 0), COUNTY OF rQrLc_rA
The for oing instryjment was acknowledged before me The f r oing instrument was acknowledgVby
efore me
this day of I�b 26L by this day of 20
L txn c-c (s
Name of person making statement Mme of person king stateme t
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Iden ' ication Type of Identification
Produced Produced
KARLA YUGOVICH KARLA YUGOVICH
(Signature of Notar �� I _ 1p y�� &a ate of Florida (Signature of N t bY� 6d t� o on a
ommission GG 207273 �' o: Commission G 207273
E fires Qpr 15,2022 ' pF off` mm.Expires Apr 15,Z022
Commission No.t✓1 O►' ghN I VNotaryAssn. Commission No. d' ughNatiJ&eW)aryAssn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17