HomeMy WebLinkAbout1105-0168 APPLICATION FOR REPLACEMENT FRONT DOORDATE: PERMIT NUMBER:
BY
No"510 l6
DUA
-� PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Fort Pierce, FL 34982
(772) 462-1553
I
APPLICATION FOR REPLACEMENT OF
WINDOWS, SKYLIGHTS, DOORS & OVERHEAD GARAGE DOORS
1. LOCATION/SITE ADDRESS:
2. PARCEL ID NUMBER: �� 4n)qe44 F 1) U �J - 4E)07— —7DI Moo 4S
3. DESCRIPTION OF PROJECT OR
PLW r=
4. TYPE OF STRUCTURE: SIR
5. OWNERS INFORMATION
Name: 1�0 floQ y- �l 1)(-/
Address:
�2 p(o x� City: State:
Zip: Phone:717--Zl�q i 33,C)
MOBILE HOME
OTHER
6. CONTRACTOR'S INFORMATION
FL Reg/Cert #:
IAtll—
County Cert #:
Business Name:L'I�-tC
Phone Number: -Z)4J0Z
Opening Design Pressure
Design
Windows, Swing Doors,
A.S.C.E - 7 �
Pressure
Manufacture
Model,#
Method of Attachment #
Skylights, Fixed Glass
Product
FI rida Produgt Approval #
i
120 mph
130 mph 140 mpheA-m
Windows & Skylights
Exposure B
Exposure C
Overhead Garage Doors
< 30' - F.B.C. Table 1609.6 (1) + 1609.6 (2)
B- Size
C- Size
7. VALUE OF CONSTRUCTION: $ �w FEES DUE:
RECEIPT: c
OWNER'S AFFIDAVIT:. I certify that all of the information contained in this application is correct and that all work will be done in
I compliance with all appl, blie���lating construction and zoning.
1f` -p IC AMJi�Ij
PRINT QUjA�LIFIIIERS�/OW^NAERS NAME IGN R F UALIFIER/OWNER
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF , 20A BY WHO IS P SONALLY K OWN TO ME OR WHO
HAS PRODUCED AS IDENTIFICATION.
T OTARY TYPE OR PRINT NAME OF NOTARY
TITLE: NOTARY PUBLIC COMMISSION
"' ARE CZERONSIG
NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMM T hV1XMff&ANM8M7YC R PAYI1�
y EXPIRES: May 14, 2013
Bonded Thru Notary Public Underwriters '