HomeMy WebLinkAboutPERMIT APP37�
All APPLICABLE INFO MUST BE COMPS TED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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
Building Permit Application
Commercial Residential
PERMIT TYPE: L6iV1 JoLo' riot) V"
PROPOSED IMPROVEMENT LOCATION:
Address: 5305 STATELY'OAKS ST, FORT PIERCE, FL 34981
Property Tax ID #: 3404-710-0009-000-2 Lot No.
Site Plan Name: Block No.
Project Name: JASON & TIFFANY HEISLER
DETAILED DESCRIPTION OF WORK:
eplace I Windows & 1 Doors
CONSTRUCTION INFORMATION:
Add it io na I wo rk to be perfo rm ed underthispermit— checkallthatapply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters
Electric —Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: ��jj Gt Sq. Ft. of First Floor: _
Cost of Construction:$ Iq, Utilities: _Sewer _Septic
J Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameJASON & TIFFANY HEISLER
Name: BILLY SHAWN SHAPIRO
Address:5305 STATELY OAKS ST
Company: LOCK TIGHT IMPACT WINDOWS & DOORS
Add ress:15951 SW 41 ST
City: FORT PIERCE State: FL
Zip Code: 34981 Fax:
Phone No.772-215-2198
City: DAVIE State:FL
Zip Code: 33331 Fax:
Phone No 954-686-6711
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above
E-
unocktightimpact.com
rffai J' e or Coty License CGC1528924
S.
If value of construction is 52500 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.
DESIGNER/ENGINEER
Name:_
Add ress:
City: _
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:_
Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certifythat no work or installation has commenced priorto 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."
Sig ature o Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE FLORIDA `
COUNTY OF UC'A-C,
STATE OF FLORIDA-)
COUNTY OF_
- t_
The forgoing instrument was acknowledged before me
this day of 20by
The forgoing ins ument was gcknowledge before me
this day 2
Ans
_ of y
i—r -----
Narne of person Jaking stateme .
Name of person making statement.
Personally Known _ OR Produced Identification _--
Personally Known _-- OR Produced Identification ---
Type of Identification ennnt.
Type of Identification
Produced PPP��
----- ES D. HOWELL
Produced �PuvP,',
--- --- _
My COMMISSION # GG916937
EXPIRES September 262023
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(Signa` ur otary Public -State of Florida I
(Signature otfry Public -State of Florida j
Commission Noa@039 (Seal)
Commissi n o. C� (� (Seal)
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Rev. 27