HomeMy WebLinkAboutPermit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
v �
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 4624578
Address: 135 NE Penlynn Ave Port Saint Lucie, FL 34983
Property Tax ID #: 3419-570-0114-000-9
Site Plan Name:
Project Name: Xiomara Canela
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
Residential �L
Lot No. 16
Block No. 81
_Mechanical _Gas Tank _Gas Piping _Shutters � Windows/Doors _Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction:
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Name Xiomara Canela
Address: 135 NE Penlynn Ave Port Saint Lucie, FL 34983
City: Port Saint Lucie State. _
Zip Code: 34983
Phone No. 917-500-0184
E-Mail:
Name: Scott Berman
Company: Florida Window &Door
Address: 1125 N Dixie Highway
Fax: (City: Lake Worth
Zip Code: 33460
Phone No 561-3404300
Fax:
Fill in fee simple Title Holder on next page (if different E-Mail howard@floridawindowanddoor.com
from the Owner listed above) State or County License 28576
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.
State: FL
SUPPLEMENTAL CONSTRYCT10N LIEN LAW �NFORMATIOIU
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.
Signs ture of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contrac Icense Holder
STATE OF FLORIDA's",
O gs • Ho�
STATE OF FLORIDA
COUNTY OF (JI-�YY1 La��'1
COUNTY OF PaImBeach
;s.,o°�Sworn
to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before c
OF
IN
Ph sical Pres nce or Online Notarization
' Ph sical Presence or Online NotaD
Ime
is day of 2�20 by
this day of N
a 3
iomara Canela
Scott Berman = 3 N
Name of person making statement.35
ame of person making statement.
w
ersonally Known OR Produced Identification
Personally Known X OR Produced Identificatio
-
ype of Identification
Type of Identification
U
rodmed
A n�j��
Pr q0V d
:5
N
(Sign ure of Notary lic- State of Florida)
(Signature of Notary Public- State of Florida )
'
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20