HomeMy WebLinkAboutCompleted Building Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date; /0//a/a< Permit Number:IDjluji
Building Permit Application
Planning and Development Services
Buiiding 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. Qgrage Door Replacement
PROPOSED IMPROVEMENT LOCATION:
Address: 2245 NW Seagrass Drive, Palm City, FL 34990
Property Tax ID #: 4426-805-0020-000-7
Site Plan Name: N/A
Project Name:.N/A
Lot No._
Block No.
DETAILED DESCRIPTION OF WORK:
Remove and replace 18' X 7' overhead sectional garage door.
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 v/ Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2,450.00 Utilities: Sewer Septic Building Height:
Pond
Pitch
OWNER/LESSEE:CONTRACTOR:
Name E Willson Baker Name: Kevin R. Matyjaszek
Address: 706 Hayes Ave
City: Fremont State: OH
Zip Code: 43420 Fax:
Company: Excelsior Construction Roofing
Address: 2417 SW Washington Street
City: Port St. Lucie State: FL
Phone No. 419-307-2018
Mail:
E-34953 Fax:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Zip Code:
Phone No 772-418-8809
E-Mail info(5)excelsiorconstruction.net
N/A
State or County License CGC1521911
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
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:Address:
City: State:City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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
with lender or an attorney before commencing work or recording your Notice of Commencement.
Signature of Ovmer/ Ldssee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF luc/^
Sworn to (or affirmed) and subscribed before me of A^^hvsical Presence or
this day of , 20_^ by
Online Notarization
L
Name of person making staterri^t.
Personally Known.OR Produced Identification
Type of Identification Pr®duced_
(Signature of Notary Pultljc- State orplorida)- State orplorida) \J U ^
1
1
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^ BLANCO-GONZALEZ
Notary Public - State of Florida
Commission tt HH 068409
Xpn My Comm. Expires Dec 1, 2024
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