HomeMy WebLinkAboutSIGNED PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
°� " � ° � �`-"� Building Permit Application
Planning and Development Services
BuildingondCodeRegulationDivision Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:�MPACT WINDOWS
PROPOSED IMPROVEMENT LOCATION:
Address: 9400 S OCEAN DRIVE 201 B
Property Tax ID #: 3535-702-0008-000-3
Site Plan Name:
Lot No.
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
INSTALL ( )IMPACT WINDOWS
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New Electrical Meter Second Electrical Meter
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 Pitth
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �� 1 . 1 _� Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Leslie A, Heather & Michael V Bennet[, JR
Name: MADELYN GUZMAN
Address:9400 S OCEAN DRIVE 201 B
Company: WRIGHT'S IMPACT WINDOW &DOOR LLC
City: JENSEN BEACH State: _
Zip Code: 34957 Fax:
Phone No. 516 884 4942
Address:7816 S DIXIE HWY
City: WEST PALM BEACH State:FL
Zip Code: 33405 Fax:
Phone No(561)588-7353
E-Mail: whytitle1l@yahoo.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Permit@wrightswindow.com
State or County LicenseCBC1262617
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.
I
SUPPLEMENTALCONSTRUCTION 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 contlict 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.
Inconsideration 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 attorne before commencin work or recordin our Notice of Commencement.
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Si nature of Owner/ Lessee/Contractor as Agent for Owner
Signature of ontractor Lice older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF PALM BEACH
COUNTY OF PALM BEACH
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
� Physical Presence or Online Notarization
xx Physical Preece or Notarization
this is day of MAr zozi , 2t1y9 by
_Online
thi ' day of ' 0.7/ 2@Lb by
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LESLIE A BENNETT
MADELVN GUZMAN �
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Name of person making statement.
Name of person making statement. o
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Personally Known xx OR Produced Identification
Personally Known xx OR Produced Identifcati � o � d
Type of Idensi cation
Type of Identification �� s
Produc
Produced d � � � c
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i ., •""">`•,,, JAY NATHAN BRESSLER
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