HomeMy WebLinkAboutPermit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Permit Number:
Building Permit Applicatio
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
PERMITAPPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 5200 Seagrape Drive, Fort Pierce, FL 34982
Property Tax ID #: 3402-608-0266-000-1
Site Plan Name:
Project Name: Paul Marcussen
DETAILED DESCRIPTION OF WORK:
J006
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
Residentia
Lot No. 10
Block No. 48
Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic
Roof
Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Paul Marcussen (LF EST)
Name: Scott Berman
Address: 5200 Seagrape Drive
Company: Florida Window & Door
City: Fort Pierce State: _
Zip Code: 34982 Fax:
Phone No. 772-333-8347
Address: 1125 N Dixie Highway
City: Lake Worth State: FL
Zip Code: 33460 Fax:
Phone No 561-3404300
E-Mail: pinkie7l@att.net
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail howard@floridawindowanddoor.com
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:
Zip: Phone:
City: State:
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.
Signature of Contract nse
Signature of Own er7 Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swo n to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
this day of f-lVt) 2021 by
Paul Marcussen
STATE OF FLORIDA
COUNTY OFPalm Beach �,�•,�
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worn to (or affirmed) and subscribed before me of '�Qc'
P sical Prese ce or. Online Notarization "
this y day of y m z
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Scott Berman co 3 D �o
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Type of Identification W °
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Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
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(Signat of Notary P c- S rida) State of Florida
(Sig re of Notary Public- State of Florida )
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