HomeMy WebLinkAboutphillip smoak permit ap (2)All APPLICABLE INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:% ,� Permit Number:
S-IT,- Ul _Its - F
Yn`
L"T." ` a Building pp 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: Window replacement Sle to SIZE',
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Address: 5051 N HIGHWAY A1A . Unit 17-3
Property Tax ID #: Lot No.
Site Plan Name: Phillip Smoak Block No.
Project Name: Phillip Smoak
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indow replacement sie to size to IMPACT SINGLE HUNG
New Electrical Meter Second Electrical Meter
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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: $ T 00 Utilities: _ Sewer _ Septic Building Height:
Name (3F�€ tt rl; r sh
Name: i�1� h i l C'
Address: X5KI 0J Arf t) t i'
Company: ) i 1 �� � \AAA011�1 4- p
City: y,ei'dY✓ State:'"
Address:1gOq Vtnehew ytf Wxt4
City: I � State: r�
Zip Code: ;144" Fax:
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Phone No. '7T1" 4-1q' i�0
Zip Code: � bl Fax:
Phone No 91 A -
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail fe�x
?aer County License_
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Cement isrequired.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
t
1N tAW
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY
Name: _
Address:
Citv:
Zip: _ Phone
BONDING COMPANY:
Name: —
Address:
City:_----__�
7ip: Phone:
_ Not Applicable
State:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Applicntion 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 i% in conflict with and applit.able Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with \Four 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 time approved plans, the Florida Building Codes and St. Lucie County Amendments.
Thr- 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.
Luci�it\ And posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wi , -', r an attorney before commencing work or recording our of en cement.
Wa tirr- o' Owner; Lessee/Contractor as Agent for Owner Signature(o tontr4cfor/License Holder
1 /
STATE OF FLORID STATE O FLODA
COUNTY Of COUN OF
Sworr tc for affirmed) and subscribed before me of ' Sw4QLn or affirmed) and subscribed before me of
-vt-Miysical Presen or Online Notarization ,�h ysical Presence r Online Notarization
this � day of 202t by this S day of 202� by
IJ
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification .6 i -63 Type of Identification ,}7
Produced Produced ("l.
o� 0 -v
,' _
(Signature of Notary MR 4 Signature of Notary P = to of ri l SAN R KI M
1;,.,NDRA KIM ,�::��� ""4� Notary Public r ate of Florida
Noterylpuglic - State of Fl59 _ Commissio GG 944159
� Commission No. - '� Cor i�tgga6k�iiar� M GG 944159 ommission No.
My Comm. Expires 01-05.202 My Comm. Ex i s 01-05-2024
But, ad Through ` Bonds rough
American A& o0otiun of Nutria
-- - °stttt�� i ion of Notaries
REVIEWS FRONT ZONING SU LANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE ---- --- -
COMPLETED