HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMITTYPE: Doors
PROPOSED IMPROVEMENT LOCATION:
Address: 10116 Crosby Place Port St Lucie, FL 34986
Property Tax ID #: 3327-709-0021-000-2
Site Plan Name: Khamvongs
Project Name: Khamvongs
DETAILED DESCRIPTION OF WORK:
Replacement of 2 SGD with Impact
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Lot No. 07
Block No. 36S
_Mechanical _Gas Tank _Gas Piping _Shutters ) Windows/Doors
_ Electric _ Plumbing _Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 19,250
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
Name Nit Khamvongs
Address: 10116 Crosby Place
City: Port St Lucie State: r1 -
Zip Code: 34986
Phone N0.813-888-0975
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
F value of construction is 525M or more. a RECORDED
CONTRACTOR:
Name: Jeffrey Walsh
Company: Liberty Impact Windows & Doors
Address: 257 SE Monterey Road
City: Stuart State: FL
Zip Code: 34994 Fax: 772-324-8578
Phone No 772-444-7112
E -Mail info@libertyimpactwindows.com
State or County LicenseCGC 1528257
is mnuirert.
If value of HVAC is $7,SW or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Not Applicable MORTGAGE COMPANY: 1� 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:
FRONT
Name:
Address:
PLANS VEGETATION
Address:
City:
MANGROVE
City:
Zip: Phone:
REVIEW
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
WfTH TOUR ENPOSTED ON EpERt AN TTO EY EBEFORE RECORDING YOUR NOTICE OF COMM 'fAIEMENTNCIN CONSULT
re o caner/ Lessee/Contractor as Agent for Owner
Signature of ractor/License Holder
STATE OF FLORI
COUNTY OF Gl
STATE OF FLORIDA ,,/�� 1
COUNTYOF If Kli'1�.�1
The forgoing instrument was acknowledged before me
this�dayof a1al 2040 by
The for oing inst t was acknowledged before me
this Indayof�20_gOby
Name of person making sta ent.
Personally Known OR Produced Identification
Name of person making statement.
Personally Known L OR Produced Identification
Type o entification
Type of Identification
Prod ed
Produced
(Signature of Notary Public- State of FIit
Commission No.
CHRISTINA of8ienatur of Notary Public- State
�+� • „*'. Notary Public Sl ite of Florida :J• r1p{ CHRISTINA FORTIN
�=
I�� N,y Comm. Et vlr i Nor 93 4l `( ;p�Tao mission k GG 917
Bonded through Nation I Notary Assn. ���s`..�' My Comm. Upires Dec 5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
nev. y rr i7
IMPACT WINnOWDOORS
Window/Door Schedule
..Size
(WXH) Window Location