HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITAPPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 4545 S Indian River DR Fort Pierce, FL 34982
Property Tax ID #: 2409-712-0068-000-1
Site Plan Name:
Project Name: Charlene Ulrich Crowe
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:.
Residential V
Lot No. 13+14
Block No. 5
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: $ _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR.
Name Charlene Ulrich Crowe
Name: Scott Berman
Address: 4545 S Indian River DR
Company: Florida Window & Door
City: Fort Pierce State: _
Zip Code: 34982 Fax:
Phone No. (772) 577-1950
Address: 1125 N Dixie Highway
City: Lake Worth State: FL
Zip Code: 33460 Fax:
Phone No 561-340-4300
E-Mail:
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
Name:
Applicable
MORTGAGE COMPANY.
Name:
Not Applicable
Address.
Address.
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER. Not
Name:
Applicable
BONDING COMPANY.
Name:
_Not Applicable
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 aiathori�e 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 restr!ct 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 attornev before commencing work or recording your Notice of Commencement.
I
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1-
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signa ure Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF :gT C,(ff�
COUNTY OF Palm Beach
Sworn to (or affirmed) and subscribed before me of
Sw( to (or affirmed) and
subscribed before me of
Physical Presence or Online Notarization
y Physical Presence or
Online Notarization
this day of a.144W5. by
this J'L day of
, 202Q by
12020
Charlene Ulrich Crowe
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 L
Produced
//
(Signature of No t Public-
(Signature of Notary Public- Stat
KELLY WILCIAMS
,*YPo NolaryPubhcStateofFl
"""'��, ride
Commissi o vvoa�,l,latnry public State(gre�j�
32
Commission No. i4�u�
�0 $c fcommission HH 106�
Commission # GG 931
=+ Ift3sorn
Exp'
Expires 03/21/2025
;� or Commission not
NOVE
MIDE
REVIEW
ING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20