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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: &/// Permit Number:
157.L
cos s
Building Permit Application
Planning and Development services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:Garage Door
PROPOSED IMPROVEMENT LOCATION:
Address: 9701 S Indian River Drive
Property Tax ID #: 3529-221-0002-000-6
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Install (1) 8x7 DAB Model 824 Garage Door - Dade
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION;
Residential X
Lot No.
Block No.
and #8160 Liftmaster Garage Door Operator
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ $1,648.00 Utilities: -Sewer _Septic
Building Height:
Pond
Pitch
OWNER/LESSEE
CONTRACTOR:
Name Paul Neff
Name: Paul Kubiak
Address:9701 S Indian River Drive
Company: General Garage Door Cc Inc.
City: Ft Pierce State: FJ--
Zip Code: 34982 Fax:
Phone No.561-723-1991
Address:5710 Columbia Circle
City: W Palm Beach State:FL
Zip Code: 33407 Fax: 561-845-2276
Phone N0561-844-6145
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Paul@generalgargedoor.com
State or County License#23256
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: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Address:
City:
Zip: Phone:
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 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 OWN Your failure to Record a Notice of Commencement may result in paying twice for
improvement o our pr�rty. A Notice of Commencement must b ecorded in the public records of St.
Lucie Count an osted o the jobsite before the first inspection. If u intend o tain financing, consult
with lend or attorne bigfore commencing work or recording r Notice ommencement.
4Signaturotract9
Signat of Owner/ Lessee/Contractor as Agent for Owner
License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Palm Beach
COUNTY OF Palm Beach
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
x Physical Presence or Online Notarization
this 19U day of March 2020 by
this 191h day of March 2020 by
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Prod ced
Produced
(Signature ary Public- State of Florida)
(Signature ofllrotary Pu lic- State of Florida )
1�}tY PUB4 YTONwEFlNNIAYSON
EFlNLAYSOR
Pue,Qc
Commissi commssion#GG1955(Sea])
Commission NCommson#GG1900
1);,
rMard12Expie,'
ExpieMarch 22,202
BoPE
aPEYThON
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.S/6/20