HomeMy WebLinkAboutBuilding Permit Application All APP CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '
Date: �� Permit Number:
�rFJ ���, En
ECEIVED
UG 2019
Building Permit ApplicatiPlanning and Development Servicese County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 4712 REGINA DRIVE,FORT PIERCE,FL 34982
Property Tax ID#:3403-501-0188-000-5 Lot No.
Site Plan Name: Block No.
Project Name: DEBORAH ROBBINS
DETAILED DESCRIPTION OF WORK:
Replacement Windows(5) Mpgc+
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Ll"Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$99000 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameDEBORAH ROBBINS Name:Sam Ochstein
Address:4712 REGINA DRIVE Company:Newsouth Window Solutions
City. FORT PIERCE State:FL Address:2526 Okeechobee Blvd.
Zip Code: 34982 Fax: City:West Palm Beach State:FL
Phone No. Zip Code:33409 Fax:561-4784100
E-Mail: Phone No 561-712-9000
Fill In fee simple Title Halder on next page(If different E-Mailjenniferaviles@newsouthwindow.com
from the Owner listed above) State or County License CRC1330822
If value of construction Is$2500 or more,a RECORDED Notice of Commencement Is required.
If value of HVAC Is$7,500 or more,a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION: ;
DESIGNER/ENGINEER: Not Appli MORTGAGE COMPANY: _Not Appli
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not A e BONDING COMPANY: _Not A e
Name: Name:
Ad d ress: 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 certifythat no work or installation has commenced priorto the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenantsthat may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
Inconsideration 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN HNANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OX COMMENCEMENT:'
Si ature of Owner/Lessee/Confractor as Agent for Owner Signature of Co trail i n older
STATE OF FL01PPA STATE OF FLOFADA
COUNTY OF y A M 6:2ex:xC_6, COUNTY OF 11x 1M &Cxy'h
The forgogg instrurThent was acknowledged before me The forgoing instrument was acknowledged before me
this I&day of ,26)5by this W`a'xy of Ayci V_%+ 2da by
��s�r�h (1.obbt�c �M 0�,��c►•�
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification /,— Personally Known
Type of Identification Type of Identification , JENNIFER AVILES
Produced GC Produced _ -Notary Public Cut teofFlori
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#GG 1969a
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o s oa•,- My Commission Expires
t
March 15, 2022
(Si nature o Notary Public-State of Florida I (Signatureo otary Public-State of Florida )
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
21-1119
PHILIP G. PEROTTI
lr B
State of Florida-Notary Public
'_• •= Commission # GG 166547
8 EIR NP OHM
-�' 0�i��`� December 10, 2021