HomeMy WebLinkAboutBuilding Permit App - Midway Rd All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : Permit Number :
11 u u to 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
PERMIT APPLICATION FOR :
PROPOSED IMPROVEMENT LOCATION .
Address : 10450 W Midway RD Fort Pierce , FL 34945
Property Tax ID # : 3303 -232 -0001 -000-9 Lot No .
Site Plan Name : Block No .
Project Name : Crystal Ann Speirs
DETAILED DESCRIPTION OF WORK .
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New Electrical Meter Second Electrical Meter
FCONSTRUCTION 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 : � �q Sq . Ft . of First Floor :
Cost of Construction : $ ? 1 J 13 —T I Utilities : _ Sewer _ Septic Building Height :
OWNER / LESSEE : CONTRACTOR :
Name Crystal Ann Speirs Name : Scott Berman
Address : 10450 W Midway RD Company : Florida Window & Door
City : Fort Pierce State : _ Address : 1125 N Dixie Highway
Zip Code : 34945 Fax : City : Lake Worth State : FL
Phone No . ( 772 ) 971 - 1332 Zip Code : 33460 Fax :
E - Mail : Phone No 561 -340 -4300
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 .
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 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 .
0000
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/ License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF Palm Beach
Sworn to ( or affirmed ) and subscribed before me of rn to ( or affirmed ) and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this _ day of 2020 by this day of (il (Sk 2020 by
Crystal Ann Speirs Scott Berman
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Prod d 0
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U C N
( Signature of Notary Public- State of Florida CfegnaKreo <otary P II - ate of Florida ) a a E
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Commission No . ( Seal ) Commission No , vW ✓ ( Seal ) Z = T
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGR ( � s
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIE
DATE
RECEIVED
DATE
COMPLETED
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