HomeMy WebLinkAboutApplication for Replacement of Windows, Skylights & DoorsIt
DATE: RECEIPT: t" PERMIT NUMBER: ig 1 0 t7 1., /
(J PLANNING & DEVELOPMENT SERVICES DEPARTMENT
1` �� -� BUILDING & CODE REGULATIONS DIVISION
L I✓ t�� �;'1� 2300 Virginia Avenue
_ ................................:: Fort Pierce, FL 34982
(772) 462-1553
APPLICATION FOR REPLACEMENT OF
WINDOWS, SKYLIGHTS, SWING DOORS, SLIDING GLASS DOORS
& OVERHEAD GARAGE DOORS
1. LOCATION/SITE ADDRESS: 601 (-( 5U�,jS F T ,IJ L V D /9- PI e12C e , F C 3 �-t i 6?
2. PARCEL ID NUMBER:
3. DESCRIPTION OF PROJECT OR WORK ACTIVITY: Ve P' a C e- 7- Xxi pqC �-
61 1'i-s5 w r-bo ('s SIZE 1�)2 5r� -c •Xis of Mi %S.
4. TYPE OF STRUCTURE: SFR MOBILE HOME OTHER
5. OWNERS INFORMATION 6.
Name: J s-e?14 DU )2S 6
Address: &W L( ,SUN Ft- 1'� \,V b
City: rr P(eF Cc State: E_
Zip: 3 4 °I 8 Z Phone: 7 7 Z- 7-05-- 99(A S
Email -
CONTRACTOR'S INFORMATION
FL Reg/Cert #: CP.W 11%6 56y
CountyCert #: 2 Y 5 q a' ' I r
Business Name:11 .0— p j7 t tEi ow -
Phone Number 1 !q�
Email:
COMPONENT ID.
WINDOWS
SKYLIGHTS
PRODUCT DESIGN PRESSURE
-i- `�S .O — �S. O
PRODUCT APPROVAL #
Jri •� 3
SLIDING GLASS DOOR
SWING DOOR
MULLIONS
OVERHEAD GARAGE DOOR
[] Attach 2 copies of the Product Approval with details to the product being used.
VALUE OF CONSTRUCTION: $ 70�1 G FEES DUE:
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in
compliance with all applicable laws regulating construction and zoning.
_ (J c `l s I -e. _fZ_Av- D I p L ,�e+�a.,.� &PRINT OWNER OR C:OWF1iACTOR/QyUUALIFIER NAME SIGNATURE OF OWNER OR CONTRACTOR/QUA-
LIFTER--STATE OF FLORIDA, COUNTY OF L -3reT ST LU CI 'C, 2
ACKNOWLEDGED BEFORE ME THIS DAY OF 2k BY -- I�
WIGNATUIREOFN
=TA
O OR WHO HAS PRODUCED AS IDENTIFICATION.
TAPE NAME F NOTARY SEAL
TITLE: NOTARY PUBLIC COMMISSION NUMBER 6C :1 16(vt
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT.
AMBER FLENKER
NOTARY PUBLIC
STATE OF FLORIDA
Comm# EE215692
19�
Expires 7/11/2016