HomeMy WebLinkAboutMOSELEYAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �a' l �'� Permit Number:
VAO
...ram 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:Garage door"
Address: 5401 Hickory Dr
Property Tax ID #: 3402-609-0199-000-3
Site Plan Name:
Project Name:
Replace 16'2" x 7'9" garage door
FL# 16546.4
New Electrical Meter Second Electrical Meter
Lot No.21
Block No. 57
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: _
Cost of Construction: $ 1733.00
Name Lori Moseley
Address:5401 Hickory Dr
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
City: Fort Pierce State: E--
Zip Code: 34982 Fax:
Phone No.860-508-4181
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Connie Grace
Company:D&D Garage Doors PSL
Address:435 NW Enterprise Dr
City: Port St Lucie
Zip Code: 34986 Fax:
Phone N0772-460-7630
E7MailTiffany@ddgaragedoorspsi.com
State or County License31521
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.
State: FL
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.
Signs ure of Owner/ Lessee Contractor -as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLOR DA
STATE OF FLORID
COUNTY O
COUNTY OF
Swo n to (or affirmed) and subscribed before me of
Swo to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
thT� day of r ���e^-s�Y .�' 2020 by
this 1 C day of '� t�[`c� 12020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known \50 OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of Notary iublic- Stat Florida )TIFFANY METZGER
(Signature of Notary Publi - State of Flori a )
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