HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: August, 2021 Permit Number: 21 / �'
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Planning and Development Services St.
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: 1105 KINGSWOOD LN FT. PIERCE, FL 34982
Property Tax ID #. 3404-807-0011-000-6
Site Plan Name: RONALD DAVID MAYBERRY
Project Name: RONALD DAVID MAYBERRY
DETAILED DESCRIPTION OF WORK:
INSTALL SEVEN (7) ACCORDION HURRICANE SHUTTERS
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION':
Lot No.11
Block No.
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: $ 7•673.28 Utilities: —Sewer _ Septic Building Height:
'OWNER/LESSEE:
CONTRACTOR:
Name RONALD DAVID MAYBERRY
Name: MIRIAM VAN VASSEL
Address: 1105 KINGSWOOD LN
City: FT. PIERCE State: ON-,
Zip Code: 34982 Fax:
Phone No. 772 464 5494
Company:DVT HURRICANE SHUTTERS, INC.
Address:3100 N. KINGS HIGHWAY
City: FT. PIERCE State: FL
Zip Code: 34951 Fax: 772-794-1590
Phone No772-794-1581
E-Mail dvthurricaneshuttersinc@hotmail.com
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License24394
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: _ 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 efore commencing work or recording our Notice of Commencement.
Signature of wner/ Lessee/Contractor as Agent for Owner
Signature of ontractor/Lice Holder
STATE OF FLse
COUNTY OFORIDA l
OUNTY OFSTATE OF ORIDA SZ. b/e
Swop to (or affirmed) and subscribed before me of
Physical Pre nce or Online Notarization
this day of 2020 by
Sworn o (or affirmed) and subscribed before me of
Physical Pre nce or _ Online Notarization
Th7isCi day of r 207fi by
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Name of person making statement.
Name of person making statement.
Personally Known L/ OR Produced Identification
Personally Known ' OR Produced Identification
Type of Identification
Type of Identification
Produced-)
.Luloh Sue Blume
(SIgnature of Notary ; is f �bt�iINSION # GG297M6
Produced]
�.
' n Sue Blume
(Si nature of Notary P, =• a '„ F01�MSSION # GG297846
Commission No. * • - EX P� Sj April 29, 2023
•o Bon ed T A Aaron Notary
`•• ••'F EXPt�E§gAprII 29, 2023
Commission No. - : `
'` Bonded Thru Aaron Notary
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