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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: February ,Z , 2021 Permit Number:
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Or.[Luc H P, -
P12 7 � Building pp Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: HURRICANE SHUTTERS
PR0P0SE0 1MPR0VEMEN;f LOCATION'
Address: 4949 N. HIGHWAY A1A UNIT 192 FT. PIERCE, FL 34949
Property Tax ID#: 1414-602-0073-000-4 Lot No.
Site Plan Name: SZLOSEK Block No.
Project Name: SZLOSEK
DETAILED DESCRY a 10N ,OF 11VORK: Ni
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INSTALL TWO (2)ACCORDION HURRICANE SHUTTERS
New Electrical Meter Second Electrical Meter
'CONSTRUCTION iNFORMATION: 4f� - «� �
Additional work to be performed under this permit—check all that apply: ,
—Mechanical _Gas Tank _Gas Piping X Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 2,050 Utilities: —Sewer _Septic Building Height:
OWEi?jLESSEE: CONTRACTOR
NameALAN SZLOSEK Name: MIRIAM VAN VASSEL
Address:4949 N. HIGHWAY A1A UNIT 192 Company:DVT HURRICANE SHUTTERS, INC.
City: FT. PIERCE State: Address:3100 N. KINGS HIGHWAY
Zip Code: 34949 Fax: City: FT. PIERCE State:FL
Phone No.863 446 0409 Zip Code: 34951 Fax: 772-794-1590
E-Mail: Phone No772-794-1581
Fill in fee simple Title Holder on next page(if different E-Mail dvthurricaneshuttersinc@hotmail.com
from the Owner listed above) State or County License24394
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.
SIJPPLEIVIEIVTAL CONSTRUCTION LIEN LAW I`P4F' RI�AT�IO;N
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DESIGNER/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 len er or an attorney before commencing work or recordil2g your Notice o ommencement.
Signature ofOwner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA _ n
COUNTY OF �'1 ��y�c�i�Q COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Phvsical Presence or Online Notarization Physical Presence or Online Notarization
this day of 01.oJ ;!)r,202q by this day of V'�-L\ 020 by
N me of person makingstatement. Nafne ot person making statement.
Personally Known 1/ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Prod Prod ed ` ' n Sue Blume
- • ,�� �,,,, Vivian Sue Blume7J, COMMISSION#GG297846
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As.
S PPS S: 0#11 `of r April 29'2023( gnature of Nota"u te (Signature of NotaryA April 29, 2023 Boded Thru Aaron Note
Commission No. ��i�„1��„ � Bondeal,}Aaron Notary Commission No. (Seal) Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5 6 2