HomeMy WebLinkAboutCompleted Building Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 a7 4 i;V Permit Number:
'COUNTY
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
PERMIT TYPE: Window/Door
PROPOSED IMPROVEMENT LOCATION:
Address: 14164 Cisne Circle, Fort Pierce, FL 34951
Property Tax I D #: 1306-500-0139-000-0 Lot No. 3
Site Plan Name: N/A Block No. 48
Project Name: N/A
DETAILED DESCRIPTION OF WORK:
Remove and replace overhead sectional 16'X 7' garage door.
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical Gas Tank Gas Piping Shutters
Electric Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 1,680.00
Generator
Sq. Ft. of First Floor:
_ Windows/Doors
Roof Pitch
Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name G Richard & Patricia A Scifers
Name: Kevin R. Matyjaszek
Address. 14164 Cisne Circle
Company: Excelsior Construction & Roofing
City: Fort Pierce State:
Address: 1882 SE Crowberry Drive
Zip Code. 34951 Fax: N/A
City: Port St. Lucie State: FL
Phone No. 772-467-0764
Zip Code: 34983 Fax: 772-618-6660
E -Mail: N/A
Phone No 772-418-8809
Fill in fee simple Title Holder on next page ( if different
E -Mail info@excelsiorconstruction.net
from the Owner listed above)
State or County License CGC1521911
.r value or consiruciion 1s :>LSUU or more, a KECUKDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL 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: el 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 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."
10
Signature of Owner/ e/Contractor as Agent for Owner
Signature of Contract se Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5 . 4tecle
COUNTY OF ,61. 14eele"
The forgoing instrument ledged before me
The forgoing instrument was acknowledged before me
this qday of 20 by
this day of /G(ca/�:�. , 20,V0 by
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Name of person making stat6Kent.
Name of person making state ent.
Personally Known OR Produced Identification
Type of Identification h
Personally Known OR Produced Identification
Type IdentificationAF
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Com ssion No. 664 155 `Q
Com sion No. 6&aV390 ii a_
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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