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 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Aluminum without concrete
P P}d� PROVME INS
Address: 14423 Isla Flores Avenue
Legal Description: Spanish Lakes Fairways Leasehold Estates Being Lot 14423 (Blk. 30 Lot4)
Property Tax ID #: 1306-501-0471-000/2
Site Plan Name: Spanish Lakes Fairway;
Project Name:
Setbacks Front Back
Right Side: Left Side:
Lot No. 30
Block No. 4
Infill: Construct screen room on rear of home. Truss roof and concrete are existing.
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all apply:
�HVAC
Gas Tank
❑Gas Piping
_
Shutters
Windows/Doors
Electric
Plumbing
OSprinklers
Generator
Roof
Total Sq. Ft of Construction: 10x20
Cost of Construction: $ 2,100.00
Name Susan Ketterer/Fred Dombski
Address: 14423 Isla Flores Avenue
S Ft. of First Floor:
utilities:] Sewer F]Septic Building Height:
City: Fort Pierce State: FL
Zip Code: 34951 Fax:
Phone No. 813-453-2463
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Jeff Jackman
Company: Master Craft Aluminum Products
Address: 1634 SE Niemeyer Circle
Roof pitch
City: Port St. Lucie State: FL
Zip Code: 34952 Fax: 772-335-0860
Phone No. 772-335-1177
E-Mail: mastercraftaluminum@gmail.com
State or County License: SCC131150586
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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
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
commencing work or recording your Notice of Commencement.
Signatur of er Less e/Contractor as Agent for Owner
Sign�reoft5c—L)
or/ense HolderSTAT
I DSTA
COUNTY0 ti Wae
COUNTY OF stL---,e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this �3 day of 5 In kC 20 by
this 2,3_ day of �TA j/r #_ 20 ZJ by
Jeff Jackman
Jeff Jackman
Name of person making statement
Name of person making statement
Personally Known Y OR Produced Identification
Personally Known X OR.Produced-ldentification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Floridaridda
(Signature of Notaublic- State of Florida
)
�D. Moore
Sheryl D. Moore
NOTA
Commission No. �ye@QBLIC
Commissio NOTARYPUBLIC (Seal)
0 —STATE OF FLORIDA
? Comm#
STATE OF FLORIDA
GG945237
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REVIEWS FRONT ZONING SUPERVISOR
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PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED I
Rev. 8/2/17