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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ____________________ Permit Number: _____________________
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:
PROPOSED IMPROVEMENT LOCATION:
Address: __________________________________________________________________________________________
Property Tax ID #: _________________________________________________________________ Lot No.__________
Site Plan Name: __________________________________________________________________ Block No. _______
Project Name: ______________________________________________________________________________________
DETAILED DESCRIPTION OF WORK:
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 ___ 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__________________________________________
Address:________________________________________
City: _________________________________ State: ___
Zip Code: ______________ Fax:____________________
Phone No.______________________________________
E-Mail:________________________________________
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:_________________________________________
Company:_______________________________________
Address:________________________________________
City: ______________________________ State:____
Zip Code: ________________ Fax: __________________
Phone No_______________________________________
E-Mail__________________________________________
State or County License____________________________
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.
X
Window / Door Replacement
13605 S Indian River DRJensen Beach, FL 34957
4509-801-0009-080-0
Jordan Residence
Remove and replace (2) PGT horizontal roller windows, (12) PGT single hung windows, (3) PGT sliding glass doors
(1) PGT french door and (1) PGT picture window sidelite.
Natasha D Jordan Matthew Gilmour
13605 S Indian River DR Gilmour Window & Door LLC
Jensen Beach, FL 1371 SE Vestridge Ln
34957 Port St Lucie FL
34952
772-209-8481
matthewgilmour1@gmail.com
30514
X
28,000
..
SUPPLEMENTAL CONSTRUCTION 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-resident ial use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice forimprovements 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 ·th I d tt b f . k d. N t· f C t WI en er or an a orney e ore commencing wor or recor 1n , vour_ o ice o ommencemen ·.
... / / I � -;7/ -, . "/ ./ , •
/, / Signature of Owner/ L�ee/Contractor as Agent for Owner / Sio>-'�ture of Contractor/License Holder
STATE OF FLORIDA COUNTY OF STATE OF FLORIDA COUNTY OF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this day of , 2020 by this day of , 2020 by
.
. . . . Name of person making statement. Name of person making statement .
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced
.. Produced
. .
(Signature of Notary Publ ic-State of Florida ) (Signature of Notary Publ ic-State of Florida )
Commission No. (Seal) Commission No . (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REV\EW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE RECEIVED
DATE COMPLETED iev.5/b/LU
St. Lucie St. Lucie
x x
9th October 9th October
Matthew Gilmour Matthew Gilmour
x x
GG234007 GG234007