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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 8503 S Indian River Dr - Fort Pierce
Property Tax ID #: 3518-433-0003-000-0
Site Plan Name:
Project Name: Jose Falla
DETAILED DESCRIPTION OF WORK:
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Commercial Residential xx
CONSTRUCTION INFORMATION:
C01o0IPq1 :S1A ��S
Lot No. 4
Block No.
Additional work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1 J' 0yD
OWNER/LESSEE:
Name Jose Falla
Address: 8503 S Indian River Dr
City: Fort Pierce State:
Zip Code: 34982 Fax: n/a
Phone No.281-467-8906
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
E-Mail: n/a
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: Edward J Heritage
Company: Folding Shutter Corporation
Address: 1862 Dr Martin Luther King Blvd
City: West Palm Beach State. FI
Zip Code: 33404 Fax: 561-640-8204
Phone No 561-683-4811
E-Mail info@foldingshutters.com
State or County License Si 15
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION1�,...
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone
State:
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ _s.e&/Contractor as Agent for Owner
Signature of Coor/Ucense-Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF PALMBEACH
COUNTY OF PALM BEACH
The for Ding instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 14 day of PO V 20_ by
this9day of OV 20_ by
EDWARD J HERITAGE
EDWARD J HERITAGE
Name of person making statement.
Name of person making statement.
Personally Known xxx OR Produced Identification
Personally Known xxx OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- °('&� RY PUBLIC
(Signature of Notary a
-+STATE OF FLORIDA
Commission No. � � C;G2g2789
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STATE GG2�A
Commission No. � o SJ�I
tie Expires 10/11/202?_
IMP,Expires 10/11/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19