HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
PERMITTYPE: Windows & Doors
PROPOSED IMPROVEMENT LOCATION:
Address: 5102 Indian Bend Lane
Property Tax ID #: 1312-800-0013-000-1
Site Plan Name: Wilcenski
Project Name: Wilcenski
Commercial Residential X
DETAILED DESCRIPTION OF WORK:
Replacement of 11 Windows, 4 SGD & 3 swing doors
CONSTRUCTION INFORMATION:
Lot No. 13
Block No. 34S
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ 33,000
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Mark & Lilian Wilcenski
Name: Jeffrey Walsh
Address: 5102 Indian Bend Trail
Company: Liberty Impact Windows & Doors
City: Fort Pierce State: rL
Zip Code: 34951 Fax:
Phone No. 607-435-0743
Address: 257 SE Monterey Road
City: Stuart State: FL
Zip Code: 34994 Fax: 772-324-8578
Phone No 772-444-7112
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail info@libertyimpactwindows.com
State or County LicenseCGC 1528257
If value of construction is S2S00 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 IMPRE� PROPERTY. A NOTICE OF COMMENCEMENT MUS E RECORDED AND
POSTED ON THE B BE RE HE FIRST INSPECTION. IF YOU INTEND OBT N NCING, CONSULT
WITHIYOUR LEN R A ORN BEFORE RECORDING YOUR NOTICE [OII�M [ F
4
Signature o Owner/ Lessee/Contractor as Agent for Owner
Signature of Co o cense fTolder
STATE OF FLORIDA r
COUNTY OF����
STATE OF FLORIDA
COUNTY OF
The fo oInginstruroptt was acknowledged before me
this Tday of 2 u b
The forgpInginstrunig"as acknowledged before me
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Name of person making statQment.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type j04clentification
Type of Identification
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Produced
IN (Sign re of Notary Public- Stat f'ta) CHRISTINA FORTIN
ature of Notary Public- State F(gti1fii:) CHRISTINA FORT
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