HomeMy WebLinkAboutPERMIT APPLICATION_6904 FORT WALTON AVE_HUGH AND BARBARA RUBLEAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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
PERMITTYPE:WINDOWS
�P'R!0'PO�S!)=D JIM!P�R(OVEMENT�LOCATI�ONt. �. � '
ArldrPCS. 6904 FORT WALTON AVE, FT. PIERCE, FL. 34951
Property Tax ID #: 1301-612-0166-000-7
Site Plan Name:
Project Name:
Q?ETAIlLED DES'CR�IIPTf01N O?F WOR,K ,
INSTALL (6 ) NEW IMPACT WINDOWS
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 2,045.00 Utilities: —Sewer _ Septic
Lot No. 2
Block No. 126
Windows/Doors
Roof Pitch
Building Height:
O'V1/N'E;R/LESSE E _. l.
TR - - -- --- - _ _-
CO NACTO'R.
Name HUGH AND BARBARA RUBLE
Name:JEREMIAH JOHNSON
Address:781 EASTWOOD DR.
Company:JBR EXTERIORS, INC.
City: FT. PIERCE, FL State: _
Zip Code: 34951 Fax:
Phone No.
Address: 1201 SW BILTMORE ST.
City: PORT SAINT LUCIE State: FL
Zip Code: 34983 Fax:
Phone N0772-873-0600
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail info@jbrexteriors.com
State or County License CBC 1260687
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.
WPPLEMENTAL CONSTRUCTION. LIEN -LAW INFORMATION-.
DESIGN ERIENGI NEER: _ Not Applicable
Name:
MORTGAGE COMPANY: ^ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name -
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, l do hereby agree that i will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Cbdes 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
commencine work or recordine your Notice of Commencement -
7
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Signature/61 Owner/ Lessee/Contractor as Agent for Owner
c
Signature of C &tractor/Lice a Holder
STATE OF FLORIDA
COUNTY OF S4- (.(A
STATE OF FLORIDA Ir
Cul
Q`P
COUNTY OF C(C.
The forgoing instruent was acknowledged before me
The forgoing instrument was acknowledged before me
thiQ,q .. day of 20Zo by
this day of r)A 20 7o by
i�(R."
�'f►"t°wltrt�ll .K �Iy�UI./I7"1
I/May
�PvTb�11Qy !� ��lyl_iUI"
Name of person making statement
Name of person making statement
Personally Known _7< OR Produced Identification
�n
Personally Known /-<,OR Produced Identification
Type of ldentificatio
Type of identification
Produce
Prod
(Signature of otary Public- State of Florida)
(Sig r Public- State of Florida )
Commission o.
�bT9 PfibTc State of Florida
.,PAY P&' Notary Public State of Floritla Seal)
Co is
� r enCO
e Q ,Joshua Shane Alberlco
OZoa7s
9�. e�Q�� E piirres08176/2020
My Commission GG 020879
REVIEWS
ti'4A0
FRONT
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PERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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