HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/21/21 Permit Number:
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 FORMindows
PROPOSED IMPROVEMENT LOCATION: __
Address: 9107 Champions Way
Property Tax ID#: 3334-501-0080-000-7 Lakes at PGA Village Lot No. 2
Site Plan Name: Bob &Anna Shulha Block No. B
Project Name: Shulha Windows
DETAILED DESCRIPTION OF WORK; -
Replacing 4 Windows with Impact Rated Products
Single Hung SH-5500 NOA#20-0401.03 Mull Bar NOA#20-0406.03
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: $ 4,872.00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Robert Shulha Name:Michael O'Donnell
Address:9107 Champions Way _ Company:O'Donnell Contracting LLC
City: Saint Lucie West, FL State: Address:1740 NW Federal Hwy
Zip Code: 34986 Fax; City: Stuart State.FL
Phone No.631-678-2338 Zip Code: 34994 Fax:
E-Mail: Phone No772-408-0200
Fill in fee simple Title Holder on next page (if different E-Mail odonnellpermitting@gmail.com
from the Owner listed above) State or County License CRC1331273
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 CONSTRI�N
X_otA'pp
EN LAW INFORMATION:
DESIGNER/ENGINEER: licabl MORTGAGE COMPANY: 4' 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 Coun 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 mus a recorded in the public records of St.
Lucie Coun y and posted on the jobsite before the first inspecti f yo intend to obtain financing, consult
with lenOr or an attornov befoce-commencii-IR work or reco okeNotice of Comme cement.
Igna re wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF MARTIN COUNTY OFMARTIN
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
x Physical Presence or Online Notarization x Physical Presence or Online Notarization
this 21ST day of JANUARY , 2020 by this 21ST day Of JANUARY 2020 by
MICHAEL O'DONNELL MICHAEL O'DONNELL
Name of person making statement. Name of person making statement.
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Notar Public-State of FI ida ��
(Signature Y�� ��pp � }} (Signature o atary Public-State of Florida )
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Commission No. a� ••c Com"QG366562 Commission No. �� '•, Wynn l� n
Expims:Sept,30,2023 14017111711.#U� &�5 62
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGE•fWN t��` a'TLIE nM`t ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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