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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 09/03/2020 Permit Number: C100��'to /(L
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:JAMES & ANGELA SIMPSON
PROPOSED IMPROVEMENT LOCATION:
Address: 4405 SOUTH INDIAN RIVER DR FORT PIERCE FL, 34982-7767
Property Tax ID#. 2436-233-0001-010-1 Lot No.
Site Plan Name: Block No.
Project Name:
FDETAILED DESCRIPTION OF WORK:
REMOVE AND INSTALL IMPACT WINDOWS
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 s'Windows/Doors _Pond,
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name JAMES SIMPSON Name:STORM TIGHT WINDOWS INC
Address:4405 S INDIAN DR Company:ALPHONSE CAMPENELLI
City: FORT PIERCE State:_ Address:500 SW 12TH AVE
Zip Code: 34982 Fax: City: DEERFIELD BEACH State:FL,I
Phone No. Zip Code: 33442 Fax:
E-Mail: Phone No 561-420-0271
Fill in fee simple Title Holder A next page(if different E-Mail
from-the Owner listed above) State or County License oQC o v,6-oq
If value of construction is 2506 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.
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SUPPL CONSTRUCTION LlE LAW INF 1
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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI / STATE OF FLO DA
COUNTY OF � � COUNTY OF I ,'/'W
Swor to(or affirmed)and subscribed before me•of S_wy{f5, to(or affirmed)and subscribed before me of
r/ Ph ical Presence or Online Notarization Physical Presence or Online Notarization
this °y of s 2020 by this day of- / 2020 by
Na�of person making statement. Name o person making statement.
Personally Known V____OR Produced Identification Personally Known V�OR Produced Identification
Type of Identification Type of Identification
Produced,
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(Signs of Not P I' -State m _ ridgy ;una 'o 'o _ (Signat of Not a ic-State of Florida.
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REVIEWS FRONT ZOI�(iVE ,to r,FP6VISOR PLANS VEGETATION SEATURTL
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW �// /i/) iUPT
DATE
RECEIVED
DATE
COMPLETED
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