HomeMy WebLinkAboutBuilding Permit ApplicationAll 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: 5503 Place Lake Dr Fort Pierce, FL 34951
Property Tax ID #; 1312-502-0119-000-9
Site Plan Name:
Project Name: Donna Darrow
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
Residential
Lot No. 259
Block No.
_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: $ I,� Utilities: _ Sewer _ Septic Building Height:
Name Donna Darrow
Address: 5503 Place Lake Dr Fort Pierce, FL 34951
City: Fort Pierce State: _
Zip Code: 34951
Fax:
Phone No. (772) 242-8375
E-Mail:
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 State: FL
Zip Code: 33460 Fax:
Phone No 561-340-4300
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.
SUPPLEMENTAL CONSTRUCTION
LIEN LAW
INFORMATION,
DESIGNER/ENGINEER:
Name.
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone.
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name.
_ Not Applicable
BONDING COMPANY. _Not Applicable
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conuict 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 attornev before commencing work or recording your Notice of Commencement.
Signature of Owner
ctor as Agent for Owner � Signature
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � � `.,e.�_ COUNTY OF Palm saacn
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 3 �,t.. ` 12020 by
Donna Darrow
Name of person making statement.
Personally Known _k,,O OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State o 'da )DADA HARRIS
�®` tate of Florida
Commission No. 040TARy a R ommission: HH 89
Expires: 02/08/2025
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Sworn to (or affirmed) and
subscribed before me of
P slcal Presence o Online Notarization
this � day of 202aby
Scott Berman
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Produced
nature of Nota/ry Public- State of
mission No.�f �Oo�
��►'`Y "�,p Notary Public S
'f� Hunter Allen
N(_ I); My Commission
or n Expires 03/21/21
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