HomeMy WebLinkAboutBuilding Permit AppAll 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 Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 4624578
Address: 103 Queens Rd Hutchinson Island, FL 34949
Property Tax ID #: 1423-602-0011-000-0
Site Dian Name:
Project Name: Sandra Matula
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:
Sq. Ft. of First Floor:
Lot No. 11
Block No. 25
—Pond
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
Pitch
Name Sandra Matula Name: Scott Berman
Address: 103 Queens Rd Company: Florida Window &Door
City: Hutchinson Island State:, Address: 1125 N Dixie Highway
Zip Code: 34949 Fax: City: Lake Worth State: FL
Phone No. 772-302-0434 Zip Code: 33460 Fax:
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Phone No 561-340-4300
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 NAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
le
SUPPLEMENTAI, 31�ISTRU 7TI0eelee LIEN I(IIel
F 3R f1 'il }NIle.le
7'v
l'eelelel ell III
ee le „_,
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address.
City: States,
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.
I
ILI r cTtv�c
Signature of ContracTorfttCense Holder
Signat r of Owner/ essee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 51 L.L,tcL-1�
COUNTY OF Pahn Beach
Swor to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
�Physical Presence or. Online Notarization
this IS day of o 6 Lk/ , , 202O by
this 11rday of _� 202&by
Sandra Malula
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 FLDL-
Produced
INELI
Sig t e of Nota y Public- Sta lori a
(Sig ature of Notary Pubilc- Stat of•t ) JENNIFER CAMPBE
Notary Public • State of
Z
�io��9use aa�ldxg�'
Commission # GG 9A8
No. `''�oF�any Comm. Expires Jan tj�1
2$ 9! v uoleslwwoo AwCommission
ission No. 2L1b,1\� ( eA;iej B jafiuuar '
Bonded through National Nota
Assn, t?pu®Id ►o ®leis olignd tiUloN
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20