HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: August 17;, 2020 Permit Number: 42 OD 1 O
RECEIVED
91ro
Building Permit Application permitting Departm,
St. Lucie county
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:HURRICANE SHUTTERS
PROPOSED IMPROVEMENT LOCATION:
Address: 6719 De Leon Ave. Ft. Pierce, FL 34951
Property Tax ID #: 1301-611-0192-000-5
Site Plan Name: CAMPLIN
Project Name: CAMPLIN
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
INSTALL ONE (1) HURRICANE ACCORDION SHUTTER AND
ALUMINUM PANELS FOR FOUR (4) OPENINGS
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping XShutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ 5,535.7
Generator
Sq. Ft. of First Floor:
Lot No.
Block No. 109
Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name BRUCE CAMPLIN
Name: MIRIAN VAN TASSEL
Company:DVT HURRICANE SHUTTERS, INC.
Address: 6719 DE LEON AVENUE
City: FT. PIERCE State: EL
Address:3100 N. KINGS HIGHWAY
Zip Code: 34951 Fax:
City: FT. PIERCE State: FL
Phone No. 772 465 7353
Zip Code: 34951 Fax: 772 794 1590
E-Mail:
Phone No 772 794 1581
E-Mail DVTHURRICANESHUTTERSINC@HOTMAIL.COM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License24394
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
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:.
Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:_
Address:
City:_
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 Ian -der or an attornev before commencing work or recordLngvdur Notice of Commencement.
G� S
Signature o Owner/ Lessee/Contractor as Agent for O ner
Signature of C ntractor/Licens Holder
S 1
STATE OF FLCOUNTY L�
OF ORIDA
OFORIDA
- J
COUNTY OFSTATE
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
qM-Physical Presence or Online Notarization
Physical Presence or Online Notarization
this -?-,;_ day of 2020 by l
this of 2020 -by
� /dray
Name of person making statement.
Name of person making statement.
_____—OR
Personally Known v OR Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced\ n
U'o
Produced
?J_
(Signature of Notary Public- State of Florida)
Florljan Sue BIUm
(Signature of Notary Publi `-�V
Commission No. `,b eal avian Sue Blume
mission No. C Il� SION # GG297
jIyIMISSION # GG
, ' '�' E P�IRES: April 29, 202
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Rev. 5/b/20