HomeMy WebLinkAboutBuilding Permit Application, 1303-0101 DATE: y 'ECEIPT: PERNIIT N' <<ER
PLANNING&DEVELOPMENT SERVICES DEPARTMENT
• BUILDING& CODE REGULATIONS DIVISION
' 2300 Virginia Avenue
Fort Pierce,FL 34982
(772)462-1553
APPLICATION FOR REPLACEMENT OF
WINDOWS,SKYLIGHTS,SWING DOORS,SLIDING GLASS DOORS
&OVERHEAD GARAGE DOORS
1. LOCATION/SITE ADDRESS: 3 uA( k l�3e
2. PARCEL ID NUMBER d ej Z-0 d— 4040 d—
y
3. DESCRIPITON OF PROJECT OR WORK ACTIVITY: C.e
4. TYPE OF STRUCTURE:SIR MOBILE HOME OTHER
5. OWNERS INFORMATION 6. �.L,
CONTRACTOR'S INFORMATION
Name• 1hn�eiRegfCert#-Address: �i fJ e V nty Cert#:
City: _ A e.Y'ca.C�. , 'State. Business Name: G
Zip: Phone:' ' -7-7 .L/Jn Phone Number. 22
Email• Email:
COMPONENT ID. 1PRODUCTIIIIESIGN PRESSURE PWDFUCT APR AL#
WINDOWS
S"UGHTS
SL DIXG GLASS DOOR e�•_ a -
_SWING DOOR.
MULLIONS
OVERHEAD GARAGE.DOOR
[] ' Attach 2 copies of the 'Product Approval with details, tot he product being used.
VALUE OF CONSTRUCTION: $ `�i b y b FEES DUE:
owNERs AFFIDAVIT: I certify that all of the information contained in this n is cornett that work will be done in
9 compliance with all applicable laws regulating co on
PRINT OWNER OR CONTRAGTORIQUALIFIEIIR NAMES t� SIGNA NTRACTOR/QUALIFIER
STATE OF FLORIDA,COUNTY OF S4 C'.k
ACKNOWLEDGED BEFORE ME THIS DAY OF
O ER9ONALLY KNOWN TO ME OR WHO HAS PRODUCED AS IDENTIFICATION.
SIGN OF rJOTARY TYPE OR PRINT NAME OF NOTARY SEAL
TITLE: NOTARY PUBLIC COMMISSION NUMBER if lc_1 �v
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVZHMS
TO YOUR PROPERTY. -IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT, KATHLEEN WILSON
O�pRY'�
a� o,, NOTARY PUBLIC
z -STATE OF FLORIDA
Comm#EE137013
•s,NEE Ir Expires 10/23/2015
� 5
ST.LUCIE COUNTY Vinyl Siding
INSTRUCTIONS
Please complete all information in the space provided. All information must be Printed(use black or blue ink only)or Typed.
This application for replacement of Windows, Skylights,and Doors is to be used only for those activities that are not otherwise included
under a primary building.permit This application for Permit may not be used for any activity that includes any type or kind of structural.
alteration. Building activities involving structural alteration, in addition to the replacement of Windows, Skylights, Doors 8t Overhead
Garage Doors,must be permitted through the regular building permit review process. The information to be provided with this application
includes: 1
1. LOCATION/SITE ADDRESS:.............................................. Indicate the street address,or general location,of the property on
which the building activity is taking place.
2. PARCEL ID NUMBER........................................................ Indicate the Property Tax Identification Number for the property on
which the building activity is taking place.
3. DESCRIPTION OF PROJECT OR WORK ACTIVITY........ Briefly describe the building activity under permit application.
4. OWNERS INFORMATION:................................................. Indicate the name and address of the owner of the property on which
the product is to be installed.
5. CONTRACTORS INFORMATION. .................................... Indicate the State of Florida(if applicable)and St Lucie County
contractor's registration numbers,and the name of the business
doing the work.
6. VALUE OF CONSTRUCTION............................................ Indicate the total value of the work to take place. Total cost of
- - -- - - construction includes all matenaland labor costs associated witli the- -
building/construcuon activity. The value of construction is used to
determine the amount of permitting fees to be assessed St Lucie
County reserves the right to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures
are not consistent with similar types of construction.
All applications for Permits are to be submitted to the St Lucie County Building and Zoning Departmen1t,St Lucie County Administration
Building,2300 Virginia Avenue,Fort Pierce,FL 34982: All applications for Permits must be completed and filed with the Department no
later than 4:30 P.M each business day. 140 applications will be accepted for processing after 4:30 PAL For assistance in completing
this application,please contact the St Lucie County Building and Zoning Department,at(772)462-1553,during regular office hours(8:00
AM-5:00 PM),Monday through Friday.
Following the issuance of this Windows,Skylights,Doors&Overhead doors replacement Permit,the scheduling of all required inspections
maybe made by calling (772)462-1261.
SLCCDV FORM N0:006-05
Revised 4/10/2012 PDSD JC