HomeMy WebLinkAboutBuildingPermitApplication - Signed.pdfAll 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 Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: Hurricane Shutters
PROPOSED IMPROVEMENT LOCATION:
Address: 5833 Spanish River RD
Property Tax ID #: 1312-502-0128-000-5
Site Plan Name:
Project Name: Zlmka
DETAILED DESCRIPTION OF WORK:
Installation of 10 Accoridon Shutters
Lot No.
Block No.
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION: ^�
Additional work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank _ Gas Piping X Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 8,546.00 Utilities: —Sewer _ Septic
Building Height:
OWNERAESSEE:
CONTRACTOR': ----
Name Jerome Jerome E. & Kay S. Zimka
Name: Michael Heissenberg
Address: 5833 Spanish River RD
Company: Expert Shutter Services
Address: 668 SW Whitmore Drive
City: Fort Pierce State: FL
Zip Code: 34951 Fax:
Phone No. 772-464-3408 E-
city: Port Saint Lucie State: FL
Zip Code: 34984 Fax: __----
Phone No772-871-1915
Mail: jzimka@comcast.net
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail permits@expertshutters.com —
State or County License 16572
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 CON
DESIGNER/ENGINEER:
Name: Tilteco, Inc.
Address: 6355 NW 36th St. #305
City: Virginia Gardens
Zip: 33166
3TRUCTION LIEN LAW INFORMATION:
— Not Applicable -
_ State: FL
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
* Not Applicable
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone:
_ Not Appiica'l<—
State:
BONDING COMPANY: * Not Applicable
Name: _
Address:
City:
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicate,;'
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 any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions nchich 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, con%;t-tlt
with lender or an attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contrac;;�
as Agent for Owner
STATE OF FLORIDA
COUNTY OF St, Lucie
Sworjj��to (or affirmed) and subscribed before me of x Physical Presence or Online Notarization
his t�V day of ("j � _ r, 20 -2 by
Michael Heissenberg
Name of person making statement. — ------
Personally Known x OR Produced Identification
Type of Identification Produced
(Signature of Notary
State of Florida)
Commission No. GG258038 (Seal)
REVIEWS I FRONT
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DATE
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DATE
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