HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/15/20 Permit Number:
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LJ P `' t Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X_ Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:WindOWS
PROPOSED IMPROVEMENT LOC4TION:
Address: 14 caKe Vista I rail Apt. 106
Property Tax ID #: 3422-500-0188-000-1 Vista St. Lucie BLDG 14 Unit 106
Site Plan Name: Samoylo Windows
Project Name: Samoylo Windows
Replacing 5 Windows with Impact Rate Products
Single Hung SH5500 NOA 17-0630.05 Mull Bar NOA 17-0630.01
New Electrical Meter Second Electrical Meter
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: $ 5,446.00
_ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors Pond
_ Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameAnne Samoylo
Name: William H. Miller
Address:14 Lake Vista Trail Apt. 106
Company: O'Donnell Impact Windows and Storm Protection
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City: Port St. Lucie, FL State: _
Zip Code: 34952 Fax:
Phone No.914-860-6381
Address:1740 NW Federal Hwy
City: Stuart State: FL
Zip Code: 34994 Fax:
Phone No 772-408-0200
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail odonnellpermitting@gmail.com
State or County LicenseCGC035934
•• •�•�_....�>vv�uvn i> covv ur more, a Ktwnutu Notice or commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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INEER: _ N fi Applicable MORTGAGE COMPANY: _ Nicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Pho Zip: Phone:
FEE SIMPLE TITLE OLDER: Not Applicable BONDING COMPA Not Applicable
Name:
City:
Zip:.
Address:
City:_
Zip:
=ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I ertify 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
1n Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
1 aa/�n d�Ithlender or artnrnPvhPfnrPrnmmcnrinn.a,n.Ln.(..,.....d:.,.,...,.._/nl�:___t.-______._____-_.
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[Sigrlature o Owner Lessee/Contractor as Agent for Owner
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STATE OF FLORID S1�
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STATE OF FLORffo
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swor o (or affirmed) and subscribed before me of
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Sw rn to (or affirmed) and subscribed before me of
Presence or Online Notarization
F Physical Presence or _ Online Notarization
this ggday of , 2020 by
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this day of 2020 by
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Name of person making statement.
Personally Known 9/
Na�rrre�of person making tement.
OR Produced Identification
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Type of Identification
Type of Identification
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SEA TURTLE
MANGROVE
COUNTER REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
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