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All APPLICABLE INFO MUST BE-COMPLETED FOR APPLICATION TO BE ACCEPTED I,
Date: ' I - t2iljj Permit Number:
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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:Replacement of Windows & Sliding Glass Door Impact
PR®P®SaED IiI IPR®VEMENT I®CATION r 4 x,, w � , NS
Address: 9650 S OCEAN DR#2002 Jensen Beach FL 34957
Property Tax ID#: 4502-610-0182-000-5 Lot No.
Site Plan Name: ee)1_bq , Ge ofgc- Block No.
Project Name: Colby, &CL4ge`.
DETAIED ESCRIiPTI®N OF,INORKM f �
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Replacement of Windows&Sliding Glass Door with Impact
f L MbIQ 250 --
fu as -III&, ob
New Electrical Meter Second Electrical Meter
CONSTRtUCTION'I;NiFO,R+MATI®N �� j k
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 23,000 Utilities: —Sewer _Septic Building Height:
®�WNIER�/LEASSEE4. r„ s h -..; CONTRACT®R 71 j �, Y1
NameGeorge Colby Name:Jeffrey Walsh
Address:9650 S Ocean Drive#2002' Company:Liberty Impact Windows&Doors
City: Jensen Beach State: L Address:257 Monterey Rd
Zip Code: 34957 Fax: City: Stuart State:FL
Phone No.914-572-2200 Zip Code: 34994 Fax:
E-Mail:N/A Phone N0772-444-7112
Fill in fee simple Title Holder on next page(if different E-Mail info@libertyimpactwindows.com
from the Owner listed above) State or County License CGC 1528257
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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.UPPLEMENTALCONSTRUCT(ON 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 BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installations 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE PEFQRE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER mAcCATrORNEY BEFORE RECORDING YOUR NOTICE OF COMM NT."
Signature of ner/Lessee/Contractor as Agent for Owner Signature of C tractor/License Holder
STATE OF FL
STATE OF
COUNTY OFOj �,�C_I COUNTY OFO i A C'_ I.
The fo going instr nt Ir-was.a knowledg d before me The fo going instr ent was cknowledged before me
this-4—day of 20 by this day of 20� by
Name of person makingstatement. Name of person making statement.
Personally Known \1 OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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( (Signat c
Notary Public State of Florida
,p.►�' Piotary Public State of Florida Stephanie Spurlin
Com St Stephanie S urtin " . (S 1) Commis ' "14 057731 (Se
+�j * ommu►won 057731 ora Expires 10127�2024
�iq M1� Expires 10127/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19