HomeMy WebLinkAboutBUITIFUL PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial Residential /
PERMIT APPLICATION F0R:Qap3ge Door Replacement
PROPOSED IMPROVEMENT LOCATION:
Address: 20 Sovereign Way, Hutchinson island, FL 34949
Property Tax ID #: 1414-701-0158-000-8
Site Plan Name:
Project Name:
Lot No. N
Block No. "I®
DETAILED DESCRIPTION OF WORK:
Remove and replace 18' X 7' overhead sectional garage door. FYI: Door is a warranty replacement by door manufacturer.
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 Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1.250.00 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:CONTRACTOR:
Name Sorce Name: Kevin R. Matyjaszek
Address: 20 Sovereign Way Company: Excelsior Construction & Roofing
City. Hutchinson Island State" FL Address: 2417 SW Washington Street
Zip Code: 34949 pg^.Citv: Port St. Lucie state: P"-
Phone No. 772-971-0308 Zip Code: 34953 pgy;
E-Mail: msorce@h20front.com Phone No ^^2-418-8809
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail info@excelsiorconstruction.net
State or County License CGG1521911
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: Not Applicable
Name:
Address:Address:
City: State:Citv: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: 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 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 your Notice of Commencement.
Signature of Own^f/^essee/Contractor as Agent for Owner
STATE OF FLORIDA ,
COUNTY OF luc/<
Swcxn to (or affirmed) and subscribed before me of
iX Physical Presence or Online Notarizatio
Signature of Cont/actor/Ocense Holder
STATE OF FLORIDA
COUNTY OF luc/c
this JHL day of Fehr^
A UctluiM/'.r/
afdm(
n
, 202S by
Sworn to (or affirmed) and subscribed before me of
\/ Physical Presence or Online Notarization
this II-/A day of Fc£r£&:riy , 20^ by
Name of person making statement.
/Personally Known
Type of Identification
Produced A/ZA
OR Produced Identification
(Signature of Notary Public- State of Florida )
Name of person making statemem:
Personally Known OR Produced Identification.
Type of Identification ,
l^odjijicld i n AjIA
(Signatilire of Notary Public- State of Florida )
Commission No
OFfVY-
W BLANCCr-tiDMZALEZ
Notary Public - State of Florida
Commi;iiinn » HH flfiltapo
Commission No.MARiELLYWBI
Notary Public
1 Commission # HH 068409 T
Comm. Expires Dec 1, 2024 f
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imm. Expires Dec 1,
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REVIEW
2024
ASCJfERVISOR
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PLANS
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REVIEW
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REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20