HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: $ oiDo'�.0 Permit Number:
�lio�r �L
L L Q building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Garage Door Replacement
PROPOSED IMPROVEMENT LOCATION:
Address: 1308 NW Lancewood Terrace, Palm City, FL 34990
Property Tax I D #: 4426-804-0013-000-2
Site Plan Name: N/A
Project Name: N/A
Lot N o .
Block No.
DETAILED DESCRIPTION OF WORK:
Replacement of expired permit #1606-0012 for the removal and replacement of (2) overhead sectional garage doors. 18' X 8' & 6' X T
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
Electric Plumbing Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ $2,400.00 Est
Windows/Doors _Pond
_1z
Roof Pitch
Sq. Ft. of First Floor:
Utilities: Sewer Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name 4426-804-0013-000-2
Name: Kevin R. Maty'aszek
Address: 1308 NW Lancewood Terrace
Company: Excelsior Construction & Roofing
City: Palm City State: FL
Address: 1882 SE Crowberry Drive
Zip Code: 34990 Fax:
City: Port St. Lucie State: FL
Phone No. 772-336-5053
Zip Code: 34983 Fax: 772-618-6660
E-Mail:
Phone No 772-418-8809
Fill in fee simple Title Holder on next page ( if different
E-Mail info@excelsiorconstruction.net
from the Owner listed above)
State or County License CGC1521911
It value of construction is Z500 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 CONSTRUCT ON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
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 your Notice of Commencement.
Signature of Owne ssee/ ontractor as Agent for Owner
Signature of Contra icense H der
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 66, / cue
COUNTY OF 571, uLr�
Swor to (or affirmed) and subscribed before me of
Swor to (or affirmed) and subscribed before me of
t/ N riz i Physical Presence or Online ota at o n
P sical Present or Online Notarization
this day of u L10 12020 by
this day of &u5 , 2020 by
Sr�e
k1r, v/Av R. NQ 1 s z ellove.
Name of person making statemen .
Name of person making statement.
Personally Known OR Produced Identification
Personal) y Known OR Produced Identification
Type of Identification
Type of Identification
Pr uced
Pr uced
(Signature of Notary Pub - I rida
(Signature of Notary Publi
••
"� ''• CA 1NE CHENAULT
Commission No. : '�` MYSION
a p'Fi' Y pV,
� CN�►RMAINE CHENAULT
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ommission No. MY(�iWSSION#GG947824
_ , .*. # GG 947824
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=� EXPIRES:Apol24, • 2021
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� , ;; EXPIRES: April 24, 2021
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REVIEWS
,.
FRONT
PLANS
VEGETATION
SEA TURTLE
MANGROVE
ZONING
SUPERVISOR
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20