HomeMy WebLinkAboutPermit App, Hailey All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
't L(iCULe s
' ° 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 : windows
PROPOSED IMPROVEMENT LOCATION :
Address: 5113 Buchanan Dr, Fort Pierce , FL 34982
Property Tax ID N: 3402-602-0023-000-8 Lot No. 23 & 24
Site Plan Name: INDIAN RIVER ESTATES-UNIT 1 - BLK1 LOTS 23 AND 24 (MAP 34102S) Block No. 1
Project Name : HAILEY
DETAILED DESCRIPTION OF WORK :
REPLACE EXISTING WINDOWS/DOORS WITH IMPACT. (8)
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 X Windows/Doors _ Pond
_ Electric ® Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq . Ft of Construction : Sq. Ft. of First Floor:
Cost of Construction : $ 14572 Utilities: Sewer _ Septic Building Height:
OWNER/LESSEE : CONTRACTOR :
Name STEVEN L. & KATHLEEN M . HAILEY Name: Alphonse P . Campanelli
Address: 5113 Buchanan Or Company: STORM TIGHT WINDOWS
City: Fort Pierce State: E( Address : 500 SW 12th Ave.
Zip Code: 34982 Fax: City: Deerfield Beach State: FL
Phone No. (859) 312-2163 Zip Code: 33442 Fax:
E-Mail : Phone No 407-564-1800
Fill in fee simple Title Holder on next page ( if different E-Mail stormtight@teamk5 . com _
from the Owner listed above) State or County License CRC 046091
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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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 1 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 attorneybefore commencingwork or recordin our Notice of Commencement.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
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