HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
�)..J J ( io. f� K;y .
`' ', rti Building 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:
PROPOSED IMPROVEMENT LOCATION:
Address: 3870 N Highway A1A 805, North Hutchinson Island, FL 34949
Property Tax I D #: 1423-805-0045-000-0
Site Plan Name:
Project Name: Iris Van Goethem
DETAILED DESCRIPTION OF WORK:
'-A"n4C, 721t
New Electrical Meter Second Electrical Meter
Lot No.
Block No.
CONSTRUCTION INFORMATION: 7-1
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 1 5,3Z7'
_ Generator
SQ Windows/Doors
[[ _ Roof
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Iris Van Goethem
Address: 3870 N Highway A1A Unit 805
Name: Scott Berman
Company: Florida Window & Door
City: North Hutchinson Island State: _
Zip Code: 34949 Fax:
Phone No. 305-906-1743
E-Mail: irieair@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address: 1125 N Dixie Highway
City: Lake Worth State: FL
Zip Code: 33460 Fax:
Phone No 561-340-4300
E-Mail howard@floridawindowanddoor.com
State or County License CGC1509450
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:L� ('t
_
Name:
Address: G
Address:
City: ve/qvn State:
City: State:
Zip: � Phone `Cp (-ZC4e_ (1 ('Z
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 lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Own / Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �-. �p�r`c E
COUNTY OF Palm Beach
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Pr sence or Online Notarization
__,YPhysical Pres nce or Online Notarization
this 22_ day o 248 by
this -2� day of �24ae—by
Iris Van Goethem
Scott Berman
Name of person making statement.
Name of person making statement. }
o
Q
Personally Known OR Produced Identification C
Personally Known X OR Produced Identification m
Type of Identification
Type of identification a C)o r
Pr u ed
Pr ced o F`
V _ Z
0 " N
(Si e o of ublic- Stat f rida)
(Signature of Notary Public- State of Florida) "� N
41
of Florida
Commission No..`; (Seal)
Commission No. (Seal) ti -
G 343472
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.