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All APP.14CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:r
91r. LUCE
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 3100 N Highway A1A - Unit PHB05
Property Tax ID #: 1425-606-0075-000-4 Lot No.
Site Plan Name: Block No.
Project Name: Borowski
DETAILED DESCRIPTION OF WORK:
INGTAI I Af':rr)Pnir)N qHI ITTFR1A1 _
New Electrical Meter
Second Electrical Meter.
CONSTRUCTION INFORMATION:
(Affidavit required) .
Additional work to be performed under this permit —check all that apply: a
_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: $ 8991 Utilities: _ Sewer Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name Timothy & Jean Borowski
Name:.-.. Edward J Heritage
Address: 1648 Thornhill Cir
.� At _, ,. ;
Com 'an ?, Folding Shutter Corporation
City: Oviedo
State: FL ; ;a:
Adddress: 1862 Dr Martin Luther King Blvd
Zip Code: 32765 Fax: n/a
city: West Palm Beach State: FL
Phone No. 407-242-9054
E-
Zip Code: 33404 Fax: 561-640-8204
Mail: n/a
Phone No 561-683-4811
Fill in fee simple Title Holder on next page (if different
E-Mail info@foldingshutters.com
from the Owner listed above)
State or County License SCC131151041
If value of construction is 2500 or more, a RECORDED Notice of Commencement is re uifed.CRJ
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is re red. 0 ,, L.,,rr r
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIOIN
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
able
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 conflicts with anyapplicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t with your Homeowners 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 commencine work or recording vour Notice of Commencement.
Signature of O Le ractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
_XX_
this I day of FEJ3 202kby
EDWARD J HERITAGE
Name of person making statement.
Persona nown XXX OR Produced Identification
Typ f entification Produced
Geri
(Signature of Notary Public- State of Florida)
Pamela A. Evans
r
Commission No. (Seal) NOTARY PUBLIC
STATE OF FLORIDA
Comm* GG262789
s Expires 10/11/2022
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