HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9/13/21 Permit Number:
L' 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 CBDG Funding
PERMIT APPLICATION FOR: Windows
PROPOSED IMPROVEMENT LOCATION:
Address: 202 Jeffrey Lane
Property Tax ID #: 2434-803-0006-000-6 Cardinal Glen Lot No. 6
Site Plan Name: Block No.
Project Name: Dals aard Windows
DETAILED DESCRIPTION OF'WORK:
Replacing 4 Windows with Impact Rated Products
_5bnQ1e Huna SH-5500 NOA# 20-0401,03
New Electrical Meter Second Electrical Meter (Affidavit required)
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 Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _5,724.00 Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: 1 CONTRACTOR: ..
Name Pamela Dalsgaard Name: Michael O'Donnell
Address: 202 Jeffrey Lane Company:_ O'Donnell Contracting LLC
City: _Fo Rierce State: FL Address: 1740 NW_ Federal Hwy
Zip Code: 34982 Fax: City: Stuart State: FL
Phone No. 954-294-15Q4E- Zip Code: 34994 Fax:
Mail: Phone No 772-408-0200
Fill in fee simple Title Holder on next page (if different E-Mail odonnellpermitting gmail.com
from the Owner listed above) State or County License CRC1331273
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.
f SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:'
DESIGNER/ENGINEER: X Not Applicable
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
X Not Applicable
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone:
X Not Applicable
State:
BONDING COMPANY: X Not Applicable
Name: _
Address:
City:
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 conflicts with an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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
witn ienaer or an arpr�rmy before commencing work or record
ature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Martin
Sworn (or affir ed) d sub cribbed before me of X Physical Presence or
this aX day of ZO-9-,-, by
Michael O'Donnell
Name of person making statement.
Personally Known X OR Produced Identification
rvDetof Identification Produced
(Signatur� kf Notary Public- State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ur Notice of Commencement.
Online Notarization
�1
Wynn Allen
Comm.#GG366562
E_x+[p}i�re,]s: Sept 34, 202�j3
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R
0 w Notary
SUPERVISOR I PLANS I VEGETATION SEA TURTLE MANGROVE
REVIEW I REVIEW I REVIEW I REVIEW REVIEW