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Permit Number:
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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
PERMIT APPLICATION FOR:
I PROPOSED IMPROVEMENT LOCATION:
Address: 4856 N RIVER PL FORT PIERCE, FL
Property Tax ID #: 3403-502-0081-000-8 Lot No.
Site Plan Name:
Project Name: JUSTUS
DETAILED DESCRIPTION OF WORK:
REPLACE 1 SLIDING GLASS DOOR WITH IMPACT.
USING LIKE SIZES
NO STRUCTURAL CHANGES BEING MADE
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Block No,
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:
Cost of Construction: $ 5,250
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
Name Shad Mullins Slade II
Address: 150 S Bates RD
City: Taylors State: SC
Zip Code: 29687 Fax:
Phone No. 772-224-9696
E-Mail: OneJustus76aamail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: BRUCE M. TYRRELL JR.
Company:_ Kamrell Windows & Doors
Address: 8200 SW LOST RIVER ROAD
City: Stuart State: FL
Zip Code: 34997 Fax: 772-288-6208
Phone No 772-288-6205
E-Mail Sue Kamrell.com
State or County License CGC061180
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:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone:_
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:_
Not Applicable
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 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.
5 gnature of Owner/ Less e e/g4fitractor gent for Owner
STATE OF FLORIDA
COUNTY OF MARTIN
Sworn to for affirmed) and subscribed before me of hysical Presence or Online Notarization
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REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
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DATE
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pu : 5USAN MARIE GODDARD
yl Notary Public -State of Florida
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