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 Reguiation Division ComiTlGrcial RGSidGfltial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FORiQarage Door Replacement
PROPOSED IMPROVEMENT LOCATION;
Address: Floresta Drive, Port St. Lucie, FL 34983
Property Tax ID #: 3419-530-0170-000-5
Site Plan Name:
Project Name:
Lot No.19
Block No. 38
DETAILED DESCRIPTION OF WORK:
Remove and replace 9' X 7' overhead sectional garage door.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical Gas Tank Gas Piping Shutters Windows/Doors Pond
Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 2,100.00
Sprinklers Generator
Sq. Ft. of First Floor:
Roof Pitch
Utilities: Sewer Septic Building Height:.
OWNER/LESSEE:CONTRACTOR:
Name Grape Leaf Park LLC Name: Kevin R. Matyjaszek
Address: PO Box 6467 Companv: Excelsior Construction & Roofing
Citv: L'ke Worth f state: FL Address: ^417 SW Washington Street
Zlp Code: 33466 pgy; -City: Port St. Lucie state: PL
Phone No. ?34"554-8525 . %Zip Code! 34953 Fak:'
E-Mail:Phone No 772-418-8809
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail info@excelslorconstructlon.net
State or County License CGC1521911
If value of construction is 2500 or more, a RECORDED Notice of Commencement Is required.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: 1/ Not Applicable
Name:
Address:Address:
Citv: State:Citv: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: / Not Applicable
Name:
BONDING COMPANY: _y Not Applicable
Name:
Address:Address:
Citv:Citv:
Zip: Phone:Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any appiicable Home Owners Association ruies, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The foilowing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
Signature of Ownef/Lesree/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF ^
Signature of Conl$^ctor/license Holder
STATE OF FLORIDA / ,
COUNTY OF luge
Swprn to (or affirmed) and subscribed before me of
Phy;
///A day of
NOV\
1/ Physical Presence or
this Im day of
Online Notarizatio n
, 202a by
Sworn to (or affirmed) and subscribed before me of
_ Physical Presence or Online Notarization
vom
1/ F
k.
this //-f^ day of 202fl by
Name of person making statem^t.
OR Produced IdentificationPersonally Known
Name of person making statement.
,
Type of Identification
Produced i
(Signature of N
Commission No
ry Public- State of Florid
MARIELLY g^|y^O-GONZALEZ
n Notary PubTitestate of Florida
Personally Known
Type of Identification
Produced
OR Produced Identification
(Signature of Notary Public- State of Fiorida
Commission # HH 068409
rComm, Expires Dee 1, 2024
Commission No.i -ty.. MARIELLY W BLANCC(5e«W
Notary Public - State of Floridaiorida
Commission # HH 068409
ded
I comm. Expires Dec 1,
1
09 I
2024 P
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