HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: SHUTTERS
PROPOSED IMPROVEMENT LOCATION:
Address: 1815 NW BUTTONBUSH CIR
Property Tax ID #: 4426-802-0016-000-7 Lot No.
Site Plan Name: Block No.
Project Name: KUSICK
DETAILED DESCRIPTION OF WORK:
ELECTRIC ROLL -UP SHUTTERS - ELECTRIC CONNECTION BY OTHERS
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: $ 3706.00 _ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name MICHAEL ROBERT KUSICK Name: JOHN FISCHER
Address: 181S NW BUTTONBUSH CIR Company: ARMOR SCREEN CORPORATION
City: PALM CITY State: FL Address: 2744 HILLSBORO ROAD
Zip Code: 34990 Fax: City: WEST PALM BEACH State: FL
Phone No. E- Zip Code: 33405 Fax: 561 . 841 . 8892
Mail: Phone No 561.841.8890
Fill in fee simple Title Holder on next page (if different E-Mail PERMITTINGQARMORSCREEN. COM
from the Owner listed above) State or County License CGC1522990
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohlbrt 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
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signatur ❑wner/ Le see/Contractor as Agent for Owner
STATE OF FL D�rO ��O Jh
COUNTY OF _l' 1
Sworgor affir d} nd su scribed before me of _Physical Presence or Online Notarization
this l� ay of 2021 by
Name of person making/statement.
Personally Known ✓ OR Produced Identification
Type entiflcatIon Prodiced
{Signature of Notary it- State of Florida}
Commission Na.[] �5eal} y�;�J'�AN DREA HERNANDEZ
Notary Public -state of Florida
Commission # GG R23758
My Commission Expires
f'`°;,"•`� November 09 20P3
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