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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
[_Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Residential
PERMIT APPLICATION FOR: Shutter
PItQP't�S D 111lIPRQ1lEMENT LOCATI }N
l ddress: 9650 S OCEAN DR 109
(Legal Description: THE PRINCESS OF HUTCHINSON ISLAND UNIT 109
Property Tax ID#: 4502-610-0009-000-9 Lot No.
Site Plan Name: Block No.
Project Name: Clark
Setbacks Front X Back: X Right Side: Left Side:
Install 3 accordion shutters
CONSTRUCTIQN INFORTIQN.
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Additional work to be performed under this permit—check all apply:
11HVAC Gas Tank Gas Piping Shutters 0 Windows/Doors
11 Electric ❑ Plumbing Sprinklers [i Generator E] Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 5,396.00 Utilities:Sewer Septic Building Height:
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Name James&Joyce Clark Name: Michael Heissenberg
Address:619 Danbury RD Unit 215 Company: Expert Shutter Services
City: Ridgefield State:CT Address: 668 SW Whitmore Dr
Zip Code: 06877 Fax: City: Port Saint Lucie State:FL
Phone No.914-523-9328 Zip Code: 34984 Fax: 772-871-0990
E-Mail: Phone No. 772-871-1915
Fill in fee simple Title Holder on next page(if different E-Mail: Callexpert@aol.com
from the Owner listed above) State or County License: 16572
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: rite Inc. Name:
Address.6355 NW 36th St Suite 30.5 Address:
City: Virginia Gardens State: FL City: State:
Zip: 33166 Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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.
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Signature of Owner es ee/Contractor as t for Owner Signature of Contractor/License Hold
STATE OF FLORIDA STATE OF FLORIDA
CO U NTY OF St.Lucie CO U NTY OF St.Lucie
The f r oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of � �� ) 20 �Uby this ?3 day of 20 Si by
Michael Heissenberg Michael Heissenberg
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
(J��(} ZARYAS Taylor O'Brien
Commission No. `'Jl3lq o ' �sjPWkARY PUBLIC Commission No. U �otNRJSeaVaylor O'Brien
q -STATE OF FLORIDA oQ ��NOTARY PUBLIC
YS4I'Ce!(VA Expires 2/1712024 =Comm#GG958999
Revised 07/15/2014 s�`✓CE lei`° Expires 2/17/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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