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HomeMy WebLinkAboutBuilding Permit Application,Inn 10904 00© ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 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 IMPROVEMENT LOCATION: Address: 5113 Palm Dr Legal Description: Indian River Estates- Unit 07 Blk 49 Lot 30 Property Tax ID #: 3402-608-0332-000-5 Lot No. 30 Site Plan Name: Young 10964004 Block No. 49 Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: Replace 8 Windows and 1 Door Size For Size IMPACT GLASS CONSTRUCTION INFORMATION: Additional work to bfirtormed under tispermit—check a appy: ❑HVAC Gas Tank ❑ Gas Piping Shutters Q Windows/Doors Electric ❑ Plumbing Sprinklers F� Generator E]Roof Roof pitch Total Sq. Ft of Construction: _ Cost of Construction: $ 13333 SFt. of First Floor: _ Utilities:n Sewer []Septic Building Height: OWNERAESSEE: CONTRACTOR: Name Donna Young Name: Roberto Sanchez Address: 5113 Palm Dr Company: The Home Depot City: Fort Pierce State: FL Zip Code: 34982 Fax: Phone No. Address: 6500 NW 12th Ave, Suite 110 City: Ft, Lauderdale State: FL Zip Code: 33309 Fax: Phone No. 407-469-5599 E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail: robertosanchezthd@expeditepermit.com State or County License: CGC1522717 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SP E EN1 AL CONSTRUCTION LIEN LAW INFORMATION: :....:.:.: 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 an applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult withy our 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 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." V / Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF 9T- Z STATE OF FLORIDA COUNTY OF cj% Lun -C, The forgoing instrument was acknowledged before me The forgr?ing instrument was acknowledged before me this I I day of Nc.-M 20aO by this I I day of MCLrCil , 20 0 by &Z T c.,, 1A -eT, tw,77c, 5)�� V. -a C �A ­C� 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 Prod uc Produced ie meets R� Y PUBLIC h1OT� tpp, CYr (Signature of Notary ublic- St r Ff95PW • (Signature of Notary Public- State of F104 Roberts LWN2d T PUBLIC Y No. Lpa AN- OF FLC)R r�'�4 Commission No. �a . COT" FFA 04p- wmkmw Expires REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. L///1y