HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
are.
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 4624578
Address: 3309 Avenue S Fort Pierce, FL 34947
Property Tax ID #: 2405-601-0088-000-4
Site Plan Name:
Project Name: Lorraine Ingram -Williams
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
Residential
_Mechanical _Gas Tank _Gas Piping _Shutters � Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ _ � -,
Name Lorraine Ingram-Wiliams
Address: 3309 Avenue S
City: Fort Pierce
Zip Code: 34947
Mail:
Phone No. 772-332-5136
Oil
Fax:
Sq. Ft. of First Floor:
lot No.
Block No.
_ Pond
Utilities: _Sewer _Septic Building Height:
State: _
-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Scott Berman
Company: Florida Window &Door
Address: 1125 N Dixie Highway
City: Lake Worth
Zip Code: 33460
Phone No 561-3404300
Fax:
E-Mail howard@floridawindowanddoor.com
State or County License 28576
value of construction is 2500 or more, a RECORDED Notice of Comm
If encement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Pitch
State: FL
Rion
SUPP�;EMENTALrvCQNSTRUCTION LI N: CAIleW NFORMAl'ION.I
Ile
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.
Sign ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF -
COUNTY OF Palmaeach
Swo to (or affirmed) and subscribed before me of
rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Phy sical Prese a or Online Notarization
this day of Goa, 28-by
this jday of r_ 202V by
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Lorraine Ingram -Williams
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 `'. `f 66 W'ry%4 0
Produced
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20
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