HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: July 10, 2020 Permit Number: /171
Building Permit Application
Planning and Development Services
i 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: Hurricane Shutters
PROPOSED IMPROVEMENT LOCATION:
Address: 5703 UNIVERSITY LANE FORT PIERCE, FL 34951
'Property Tax ID #: 1301-604-0124-130-6 Lot No.
,Site Plan Name: =a-c'o b �jl=Block No. 32
Project Name: cc) 1�4
;'DETAILED DESCRIPTION OF WORK:
We will install three (3) Bahama hurricane shutters
i
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 2,400
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameCHRISTIAN JACOBSEN
Address: 5703 UNIVERSITY LANE
Name: MIRIAM VAN TASSEL
Company: DVT HURRICANE SHUTTERS
Address: 3100 N. KINGS HIGHWAY
City: FT. PIERCE Stater
Zip Code: 34951 Fax:
Phone No. 772 528 4503
E-Mail:
City: FORT PIERCE State: FL
Zip Code: 34951 Fax: 772 794 1590
Phone No 772 794 1581
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail dvthurricaneshuttersinc@hotmail.com
State or County License 24394
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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 our Notice of Commencement.
Signat re of Owner/ Lessee/Contractor as Agent for Owner
Signature f Contractor/License Holder
STAT OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
'Physical Presence or Online Notarization
Sworn to (or affirmed) and subscribed before me of
_-151hysica 1. Presence or Online Notarization
this 'Z72- day of �`S�.-�- 2020 by
this 12-2- day of 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known ,— OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Vivian Sue Blum
avian Sue Blume
(Signature of Notary Pu _ S o, €l I.
� .:``EXPIRES: April 29, 202
Commission No. �''�;'�F""' ��.� b 11jru Aaron Nokia
"l"
(Signature of Notary ;� i t f MOWN # GG297M
=" ' EXPI��• ril 29, 2023
Commission No. �`�' •.. . • a P
'Bonded Thru Aaron Notary
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