HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Residential
PERMIT APPLICATION FOR: Shutter
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Address: 9650 S OCEAN DR 1804
Legal Description: THE PRINCESS OF HUTCHINSON ISLAND UNIT 1804
Property Tax ID#: 4502-610-0164-000-3 Lot No.
Site Plan Name: Block No.
Project Name: Ketcham
Setbacks Front Back: Right Side: X Left Side: X
Install 3 accordion shutters
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itiona wor to a er orme under this permit—check a apply:
11HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator E] Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction: $ 5,186.00 Utilities:cnSewer Septic Building Height:
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Name Gary Ketcham Name: Michael Heissenberg
Address:43 Shore Dr W Company: Expert Shutter Services
City: Copiague State:NY Address: 668 SW Whitmore Dr
Zip Code: 11726 Fax: City: Port Saint Lucie State: FL
Phone No.516-578-6221 Zip Code: 34984 Fax: 772-871-0990
E-Mail: Phone No. 772-871-1915
Fill in fee simple Title Holder on next page(if different E-Mail: Callexpert@aol.com
from the Owner listed above) State or County License: 16572
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Tilteco,Inc. Name:
Address: 6355 Nw36th St.#305 Address:
City: Virginia Gardens State: FL City: State:
Zip: 33166 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 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 our Notice of Commencement.
Signature of Own /Lessee/Contract as Agent for Owner
STATE OF FLORIDA
COUNTY OF st.Lucie
Sworn to(or affirmed)and subscribed before me of x Physical Presence or Online Notarization
this 2$ day of OCAcAoer 2021 by
Michael Heissenberg
Name of person making statement.
Personally Known x OR Produced Identification
Type of Adentification Produced
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(Signature of Notary Public-State of Florida)
yq so Shanon O'Shea
Commission No. GG258038 (Seal) _;� o�NOTARY PUBLIC
•� -+STATE OF FLORIDA
Comm#GG258038
•ONCE 19�� Expires 9/12/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE _T
COMPLETED
Rev 5/20/21