HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
i�
L, '� - Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: of I V wlruer varuen ran(way, Tort Tierce, FL 34951
Property Tax ID #: 1301-613-0092-000-0
Site Plan Name:
Project Name: Kimberly Peterson
DETAILED DESCRIPTION OF WORM:
New Electrical Meter Second Electrical Meter
Residential x
Lot No. 7
Block No. 140
CONSTRUCTION INFORMATION: --I
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
Total Sq. Ft of Construction:
Cost of Construction: $ 1
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Kimberly Peterson
Name: Scott Berman
Address: 5710 Winter Garden Parkway
Company: Florida Window & Door
City: Fort Pierce State: _
Zip Code: 34951 Fax:
Phone No. 772-913-5398
Address: 1125 N Dixie Highway
City: Lake Worth State: FL
Zip Code: 33460 Fax:
Phone No 561-340-4300
E-Mail: k7ptrs2@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
-4:- �4. ..6 'fen
E-Mail howard@floridawindowanddoor.com
State or County License 28576
-__--- -- --..__. ___._..._ ___� ... ...... ... .. ..�..v nva.v �•a�ua,c vl a.al11111ICFIf t!MenI Is requirea.
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
Name: Name:
Address: Address:
City: State: City:
Zip: Phone Zip: Phone;
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 arrdpusted-Q the jobsite before the first inspection. If you intend to obtain financing, consult
with lepcl r an attornev before commencing work or recording our Notice of Commencement.
Signat re of Owne �ssee on or s Age or Owne
Signature of Contractor se Holder s
STATE OF FLORI`'nn—''
STATE OF FLORIDA
__-�--
COUNTY OF h
COUNTY OF Palm Beach
Sw,rn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this l,Lp day of M28 by
this lk day of 2QW by
Kimberly Peterson
Scott Berman
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known x O'R Prefiuced}eatiQ
Type of Identificat"
Type of Identification �t�sr aNotary Public State of Florida
ProAu ed
Produced 14 Carol A Hammersla
y ommission GG 343472
�'. os�' Expires 07/09/2023
(Sign r f t r f Flo
Pu li - State orida
(Signature of No ary Public- State of Florida )
+r¢� a,. Notary Public State of Florida
Com ('a 01 A Hampi cla (Se )
Commission No. (Seal)
q fly Commission GG 343472
o.stoe Expires 07/09/2023
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