HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 112020 Permit Number: (.) S L)
91ro L1�[][ RECEIVED
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DEC 1 1 2020
Building Permit Application
Permitting Department
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMITAPPLICATION FOR: HURRICANE SHUTTERS
PROPOSED IMPROVEMENT LOCATION:
off—
Address: 3116 BENT PINE DR. FT. PIERCE, FL 34951
Property Tax ID#: 1327-701-0092-000-0 Lot No.272
Site Plan Name: GROTH Block No. _
Project Name: GROTH
D RK:
INSTALL SEVENTEEN (17)ACCORDION HURRICANE SHUTTERS
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: $ 20,930.94 Utilities: —Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameJEFFREY GROTH Name: MIRIAN VAN TASSEL
Address:3116 BENT PINE DR. Company:DVT HURRICANE SHUTTERS, INC.
City: FT. PIERCE State: , Address:3100 N. KINGS HIGHWAY
Zip Code: 34951 Fax: City: FT. PIERCE State:FL
Phone No.772 323 4767 Zip Code: 34951 Fax: 772 794 1590
E-Mail: Phone N0772 794 1581
Fill in fee simple Title Holder on next page(if different E-Mail DVTHURRICANESHUTTERSINC@HOTMAIL.COM
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 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 1p4kder or an attorney bef commencing work or recording our Notice of Commencement.
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Signature ofOwner/Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
s
STATE OF FLORIDA i STATE OF FLORIDA
COUNTY OF COUNTY OF
Swor o(or affirmed)and subscribed before me of Swto(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this day of 12020 by this day of 2020.by
I Gl V l4 i r i 4
Name of person making statement. Name of person making statement.
Personally Known t__�OR Produced Identification Personally Known `� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
r, `'V"' vian ue Blume �` •• vv an Sue Blume
(Signature of Notar�wu slot (Signature of Notary elf
EXPIRES:April 29, 2023 •,,' • •'���•�`' � April29, 2023
% •....��.� �nnnma Bond �,,1
Commission No. � I... `��� BondeditgAam Notary Commission No. 4a1H Aaron Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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