HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �j l
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 Residential x
PERMIT APPLICATION FOR: Window/door
PR`OP®SED`IIVIPROVEMENT LOCATIO:N.' ` b=
t� r1
Address: 1"�-0�- "�fiTfW ooc� L n fir+ pl"tr C 4Z_ 3492 Z. .
egal Description: DRIFTWOOD MANOR-SECTION THREE-LOT 16 (0.50 AC) (OR 1619-2614)
Property Tax ID#: 3404-808-0016-000-4 Lot No. 16
Site Plan Name: ,1 Block No.
roject Name:
'Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCR"IPTION fQF}1Na0RK „ - -
REPLACEMENT OF>4'WINDOWS and'eDoor�IMPACT)
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CO"NSTRUCTIONIN4E0RMgTI'0N .
Additional work to be pertormed under this permit-check k all apply:
E1HVAC _Gas Tank Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
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Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 23000 Utilities:ln Sewer OSeptic Building Height:
ODUNERESSEE CONTRACTOR �
Name W 0 [,JC.15o r Name: ffiD1Nov,Se Ca�a_jneJ J o
Address:(20_+ t'�� �D��- LY1 Company: STORM TIGHT WINDOWS
City: State: FL Address: 5w 5w 1Z A.'re
Zip Code: 34982 Fax: City:�QerT���ca Re o_C_P1 State:FL
'Phone No.772.332.9350 Zip Code: 33442 Fax:
E-Mail: :Ts am m kNi Q'�T, Phone No. 561-420-0471
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: CRC-046-091
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU,�PLE`M�ENTL9CO�STRIJCTION�LIENY,L'AW4INFORMATIOIVTpz �; -
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
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.
Signature of Owner/Lessee/C ntractor as Agent for Owner SignatuM of Contractor/License-Holder
STATE OF FLCOUNTY OF ORI !no)CA I UG1 COUNTSTATE OY OF ORID` In 1 uujz,a"�
The for oing instrument was acknowledge efore me The for oing instrument was acknowledg before me
this day of bl()\ 20 q by this day of 20 ,by
H l &yj K�W l I �!
Name of person making statement Name of person Making sta ement
Personally Known OR Produced Identification ✓ Personally Known 1,-,O' OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Sin otary Public- ate qfP€�orida j ERED WEINSTOCK nature of otary Public-State a
WEINSTOCK
_� C mission#GG 178187 a�' om isslon#GG 178187
Commission No. 3 2?�j Q\o�*(SC
January 23,2022 Commission No. L� LL�r \�* ( P31�
�� a xal s January 23,2022
FOFF:O Bonded ThruBudgetNotaryServices 9lFOFF�OQ' nondodThru Budget Notary Sorvlcee
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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