HomeMy WebLinkAboutPERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 04/08/2021
Planning and Development Services
Permit Number:
Building Permit Application
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential YES
PERMIT APPLICATION FOR:REPLACE GARAGE DOOR
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Address: 3111 OLD EDWARDS ROAD FORT PIERCE FL 34981
Property Tax ID #: 2429-124-0001-000-1
Site Plan Name:
Project Name: COOKSON
REPLACE 16X7 GARAGE DOOR
NOA# 20-0107.05
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
_Mechanical
Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction: _
Cost of Construction: $ 2920.00
Na
_ Gas Piping
Sprinklers
Shutters
Generator
Lot No.
Block No.
YWindows/Doors _ Pond
_ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Address3k I 1 Dia EdWnyd J 9-0
City: coy+ (21 c rci_- State: EL
Zip Code: 3LIC181 Fax:
Phone No.CLP50 .7'10.5121
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: L.OrllnlG �r-1ruCT,'
Company: D #' b C' arum C rS
Address: L'� NLQ Erl'i"C 06GC Dr
City: Po ri, Sk lLL6,e_ State:
Zip Code: 3gQ2 to Fax:'TTL-Uto0 f11035
Phone No--nZ-g1pQ--11p90
E-Mail 00654 eQ1*3G C1 lra(-drnf5-PSI •COM
U
State or County License 31521
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.
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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 lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA,, , �U �
STATE OF FLORIDAS�
COUNTY OF
COUNTY OF
Sw¢rn to (or affirmed) and subscribed before me of
Swor to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
Physical Presence or Online Notarization
this day of 2020 by
this day of 2020 by
C- oo . L 6 r cAce.
Name of person makingstatement.
Name of person making statement.
V
Personally Known v OR Produced Identification
Personally Known OR Produced Identification
Type of Identification -0YPOB� MICHAELWALZA
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Type of Identification oOlkyF-U&Z MICHAELWAL
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Produced Commission#HH087
Expires February 2,2
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(Signat re of Notary Public- of Florida)
(Signature of NotaryPublic- State of Florida )
7State
Commission No. (Seal)
Commission No. i4H 0179 11 (Seal)
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