HomeMy WebLinkAboutPERMIT APPI�\� o/lgaoa
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1SS3 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:
Address: 3921 Shoveside or
Property Tax top. 1423-5615-0008-000-7 Lot No. 5 —
Site Plan Name: Block No.
Project Name: Janssen Residence
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping ✓Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: p Sq. Ft. of First Floor; _
Cost of Construction: $ /Dr Utilities: _ Sewer _ Septic
—Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Kevin & Susan Janssen
Name: Edward J Heritage
Address: 3921 Shoreside or
Company: Folding Shutter Corporation
City: Hutchinson Island State: _
Zip Code: 34949 Fax: Na
Phone No. 408-610.0326
Address: 1862 or Martin Luther King Blvd
City: West Palm Beach State: FI
Zip Code: 33404 Fax: 56"7"204
Phone No 561-683-4811
E-Mail: We
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail info@foldingshuttem.com
State or County License SCC131151041
Ir value W ConnrUalon IS pZlW of more, a HCCOHUCU nonce or commencement IS requlrea.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:_
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 Countpy 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 concumency 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
Sign
atur�Owner ss ntractor as Agent for Owner
STATE OF FLORIDA ?,.I.COUNTY OF
The fgrA f RIng Instrunr=j%as acknowledgbefore me
this day of .0 20 by
EDWARD J HERRAGE
Name of person making tement.
Personally Known _ OR Produced Identification
Type of Identification
Produced
Commission No.
Signature of Con r/Lice der
STATE OF FLORIDA �`� Mt�l
COUNTY OF
The forgoing instrung vsas acknowledged efore me
this /` dayof /"f eJ 264 by
EDWARD J HERRAGE
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida)
Panola A Evans
Commission No.NOTARY PUBlgseal)
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