HomeMy WebLinkAboutBuilding permit ApplicationAll APPLICPAIL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: , 2021 Permit Number:
,=,? I IDIPW07,
RECEIVED
1�o d�l�DL APR -1 2021
0
A _ o ,. _I Permitting Departmerr
Building Permit Application St. `o,jnt,
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: HURRICANE SHUTTERS
PROPOSED IMPROVEMENT LOCATION:
Address: 5201 INDIAN BEND LANE FT: PIERCE, FL 34951
Property Tax ID #: 1312-800-0023-000-4 Lot No. 192
Site Plan Name: HAZELLEF Block No.
Project Name: HAZELLIEF
DETAILED DESCRIPTION OF WORK:
INSTALL TWO (2) ACCORDION HURRICANE SHUTTERS
New Electrical Meter Second Electrical Meter
I.i
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank f —Gas Piping XShutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 6,230.11 Utilities: _Sewer _Septic Building Height:
OW N ERAESSEE:
CONTRACTOR:
Name PAMELA HAZELLIEF
Name: MIRIAM VAN VASSEL
Address: 5201 INDIAN BEND LANE
Company:DVT HURRICANE SHUTTERS,.INC.
City: FT. PIERCE State:..
Address:3100 N. KINGS HIGHWAY
Zip Code: 34951 Fax:
City: FT. PIERCE State: FL
Phone No. 772 370 9046
Zip Code: 34951 Fax: 772-794-1590
E-Mail:
Phone No772-794-1581
Fill in fee simple Title Holder on next page (if different
E-Mail dvthurricaneshuttersinc@hotmail.com
from the Owner listed above)
State or County License24394
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
I 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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _,Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 attornev before commencing work or recording your Notice of Commencement.
Signature f Owner/ Lessee/Contractor as Agent for Owner
Signature f Contractor/License Holder
STATE OF FLORIDA 1j
�-
STATE OF FLORIDA(?
COUNTY OF JT. tl'C i
COUNTY OF ��L /CuCI
Swgrn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Y Physical Presen or Online Notarization
this � day of �� 2020 by
1/ Physical Presenc or Online Notarization
this � day of P 1 204 by
9//14.tA ��,� �{��s.el
_
�',^iGA, I/d/t ldssel
Name of person making statement.
Name of person making statement.
Personally Known '� OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Prodyegd
Produced
�IJ(Ww�/1nJ
viu t'n/li"y*an Sup Rltjinri#:�
(Signature of Notary Pu{��yy�of F'�i�lah Sue Blume
S
(Signature of Notary P _ -'# FIe�SSION # GG297846
COreISM ION # GG297846
Commission No. B = a 2�2�Commission
:April 29,
EXP�� April 29, 2023
No.EXE '��,,,,; Bonded Thru Aaron
,`.....
��; ���•��' Notary
Bonded T iru Aaron Notary
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20