HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c Permit Number:,�00 ®o�
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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
77
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 1805 HAZELWOOD DR,FORT PIERCE,FL 34982
Property Tax ID#:2433-502-0026-000-5 Lot No.
Site Plan Name: Block No.
Project Name: HOLBERTON JESSICA
DETAILED DESCRIPTION OF WORK:
INSTALL(1)ACCORDION ON LANAI
CONSTRUCTION INFORMATION:
Additional workto be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
Electric —Plumbing _Sprinklers _Generator _Roof Pitch
,Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$3377.18 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameHOLBERTON JESSICA Name:Jeffrey Tollison
Address:1805 HAZELWOOD DR Company:All American Shutters&Glass
City: FORT PIERCE State:FL Address:1638 Donna Road
Zip Code: 34982 Fax: City:West Palm Beach State:FL
Phone No.561-629-6743 Zip Code: 33409 Fax:
E-Mail: Phone No 561-712-9882
Fill in fee simple.Title Holder on next page(if different E-MailPermits@allamericanshutters.com
from the Owner listed above) State or County License CGC 1512423
.If value of construction Is$2500 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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Add ress:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 covenantsthat 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
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4WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
j TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:
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Signature of caner/Lessee/Contractor as Agent for Owner Slgn u ont or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5+•L.l1l f— COUNTY OF 5k- f-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this -3( day of ,gkAl 4 20 Ab by this 31 day of TU-1 L4 .20_&D by
Name of person making statement. Name of person m king statement.
Personally Known OR Produced Identification t/ Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced DL-, Produced
{Sign lure of Notary P blic-Sta Flori a) tnature of NotaOA�PTO%&Ior_
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Commission No. Para�s S Gonzalez Sa a onzalez
Co mis on#HH 10592 Commission No. Comm#HH 10592
N a Commission Expires 06-15.2024 N Commission Expires 06-15.2024
C nanotar v .� Bonded Throu h-Cynanotary
oFF Florida Notary Public o a Florida-Notary Public
REVIEWS FR • PLANS VEGETAL,.
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. o aY P&4 Sasha Gonzalez otVIa oa��. Sasha Gonzalez
_ c' Notary Public,State of Florida = ° Notary Public,State of Florida
a Q My Comm.Expires 06-15-2024 a Q My Comm.Expires 06-15-2024
9 P`� Commission No.HH 10592 �T e`° Commission No.HH 10592