HomeMy WebLinkAboutPermit ApAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/28/21 Permit Number:
S � C�CrLGI✓
L % 7T7 ° c =rA� — Building Permit Application
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: Window and door replacement, size for size
PROPOSED
IMPROVEMENT
LOCATION:
i
Address: 115 QUEENS RD
Property Tax ID #: 1423-602-0005-000-5 Lot No.
Site Plan Name: Block No.
Project Name: Suarez
DETAILED
DESCRIPTION OE WORK:
Window and door replacement, size for size- 10 Windows, 5 Doors, 3 Shields
FPA#: 23505.2, 15781.18, 30505.3, 14110.1
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 _Windows/Doors _Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Constructi Sq, Ft. of First Floor:
Cost of Construction: 40469 Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE: .'
CONTRACTOR:
Name Q
Name: Robert Cornetta
Address: A9p"r` ,
Company: Coastal Green Energy Solutions
City' H.C�A1(ll� ZS�CA State: �L
T
Zip Code: I1 Fax:
Phone No. SAIS - i s �k
Address:6710 Benjamin Rd #200
City: Tampa State: FL
Zip Code: 33634 Fax:
Phone No813-512-6014
E-Mail: \,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Permitting@coastalgreenenergy.com
State or County License CGC1523579
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.
SIIPPLEMENT ALCONSTRUCTION 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:
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 Contractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF C'\ e
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _ day of 2020 by
Sworn to (or affirmed) and subscribed before me of
III Physical Presence or_ Online Notarization
this&kday of u,,W , 202t by
CSsMQ_�'CU—
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
Personally Known _ —OR Produced ,fkg ; 4- 'on
Type of Identification
Produced
9:''
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8o Fco'yMN�Sa
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
(SignatLWe of Notaryblic-- S�tatte f FloridaZ HFSV oN
Commission No.10A UWA�--t- (Seal) o�ryR'6%c
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