HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: oC- 11 Q 1 Permit Number:
9,ro RECEIVED
o FEB 11 2021
Building Permit Application
Permitting Department
Planning and Development Services St. Lucie county
Building and Code Regulation Division Commercial Residential xxxxxx
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 2171 S Brocksmith Rd
Property Tax I D#: 2317-343-0020-000-9 Lot No.
Site Plan Name: Block No.
Project Name: Rep;ace Garage Door
FETAILED DESCRIPTION OF WORK:
Replace existing 16x8 Garage Door With new Dab 16x8 Garage Door
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:$ A q ob."o Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Michael R Furgason Name:Bruce Kinkade
Address:2171 S Brocksmith Rd Company:A Champions Garage Doors
City: Ft Pierce State:_ Address:544 SW Laconic Ave
Zip Code: 34945 Fax: City: Pt St Lucie State:fl
Phone No.772.205.5817 Zip Code: 34953 Fax:
E-Mail: Phone N0772.871.5550
Fill in fee simple Title Holder on next page(if different E-Mail championdoors@comcast.net
from the Owner listed above) State or County License20349
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 NoticG'of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ER/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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA L 1 , STATE OF FLORIDA �I _
COUNTY OF k t) ,I E , COUNTY OF . 1�1O,I
SwXn to(or affirmed)and subscribed before me of Swor to(or affirmed)and subscribed before me of
V Physical Prese or Online Notarization V Physical Prese e o Online Notarization
thisL d t ay of 2020 by this�day of 2021 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification V// Personally Known OR Produced Identification
Type of Identific ' n Type of Identifiwation
Produced Produced L r
r
(Signature of (Signatu cif% afy P Eitit6ofl`fliiWN
E4. -
YREN S. NIELSEN ,a° ��_State of Florida-Notar Public
yCommission Nof Florida*gt ry Public Commis -; Commission # GG 2�
fission GG 207484 "l Sion Ex rCommission Expires
°ii`i" June 12, 2022
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