HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Vq-03j
Date: Permit Number: �
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 X Residential
PERMIT TYPE: ROLL UP DOOR
Address: 4120 SELVITZ RD
Property Tax ID #: 2432-233-0001-000-6
Site Plan Name:
Project Name:
INSTALL (2) 18 X 14 ROLL UP DOORS
Additional work to be performed under this permit —check all that apply:
i _Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
i
Total Sq. Ft of Construction:
Cost of Construction: $ 10575.00
Name ACCURATE SEPTIC HOLDINGS LLC
Address:4120 SELVITZ RD
City: FORT PIERCE State:
Zip Code: 34981 Fax:
Phone No.772-216-4277
E-Mail:
Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors .
_ Roof Pitch
Utilities: —Sewer —Septic Building Height:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: DENVER MILLER
Company: D&D GARAGE DOORS PSL
Address:435 NW ENTERPRISE DR
City: PORT ST LUCIE State: FL
Zip Code: 34986 Fax:
Phone No 772-460-7630
E-Mail TIFFANY@DDGARAGEDOORSPSL.COM
State or County License 19007
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.
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DESIGNER/ENGINEER: x Not Applicable
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MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
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.
I 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 FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signatirre of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ST LUCIE
COUNTY.OF ST LUCIE
The forgoing instrument was acknowledged before me
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The fQ rgoing instrument was acknowledged before me
this _�L day of ( 20 by
this _.�.2 day of 20-6 by
DENVER MILLER
DENVER MILLER
Name of person making statement.
Name of person making statement.
Personally Known ✓ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of Notary Public- State of PI TIFFANY MET2139hignature
of Notary Pub ic- State of Florida ) IJ
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Commission No.
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