HomeMy WebLinkAboutCompleted Building Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:.
STolME"
Building Permit Application
Planning and Development Services
Building and Code Regulation Division CoiTimsrcial RGSidsntial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Overhead Garage Door Replacement
PROPOSED IMPROVEMENT LOCATION:
Address: Riverview Drive, Jensen Beach, FL 34957
Property Tax ID #: 4504-601 -0009-000-7
Site Plan Name:
Project Name: ^/A
Lot No. 9 & 10
Block No.
DETAILED DESCRIPTION OF WORK;
Remove & replace overhead sectional 9' X 7' garage door.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical Gas Tank Gas Piping Shutters
Electric Plumbing Sprinklers Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: S 1.400.00 Utilities: Sewer Septic
/
V Windows/Doors
Roof
Pond
Pitch
Building Height:.
OWNER/LESSEE:CONTRACTOR:
Name Ronald & Katharine Peters Name: Kevin R. Matyjaszek
Address: "'^4 Riverview Drive Companv: Excelsior Construction & Roofing
Citv: Jensen Beach State:Address: 2417 SW Washington Street
Zip Code: 34957 pgx:Citv: Port St. Lucie state: PL
Phone No. 772-418-0721 ZioCode: 34953 pgx;
E-Mail:Phone No 772-418-8809
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail info@excelsiorconstruction.net
State or Countv License CGC1521911
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:
Name;
/ Not Applicable MORTGAGE COMPANY:
Name:
V Not Applicable
Address:Address:
Citv:State:Citv:State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
4 Not Applicable BONDING COMPANY:
Name:
■/ Not Applicable
Address:Address:
Citv:Citv:
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 wili authorize the permit holder to build the subject structurewhich is in conflict with any applicabie Home Owners Association rules, bylaws or and covenants that may restrict or prohibit suchstructure. 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 wiil, 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-residentiai use
WARNING TO OWNER; Your failure to Record a Notice of Commencement may result in paying twice forimprovements 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 your Notice of Commencement.
Signature of Owner^ressee/Contractor as Agent for Owner
STATE OF FLORIDA ,
COUNTY OF
Sw(^ to (or affirmed) and subscribed before me of
3 Physical Presence ory Physical Presence or Online Notarizatio
censeTlblderSignature of Contrac
STATE OF FLORIDA ^
COUNTY OF jLue/e
this day of UetU
Mq
n
, 202^1 by
SwonTto (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of.
'od-
. 2020 by
Name of person making stateiYii^nt.
Personally Known \d OR Produced Identification.
Name of person making statemeru.^
yPersonally Known OR Produced Identifica
Type of identification ,
Produced f^J/A
Type of Identification
Produced l^/A
tion
(Signature of No
> Notary Public Stale of Florida
ission No. > . \M Rachel L Anc(S®Bl)tiveraCommission
(Signature of Not
f>*' 111!Notary Public State of Florida
Rachel LCommission No.S—MrComrmssion HH 0S80S2
Ea fi^y Commission HH 058052
^ Expires 10/28/2024 xpires 10/28/2024
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20