HomeMy WebLinkAboutREPLACEMENT APPLICATION5I-1
MULL-
" ' IPI—PLANNING & DEVELOPMENT SERVICES DEPARTMENT
® BUILDING & CODE REGULATIONS DIVISION
° 2300 Virginia Avenue
Fort Pierce, FL 34982 SCANNED
(772)462-1553 BY
APPLICATION FOR REPLACEMENT OF St. Lucie County
WINDOWS, SKYLIGHTS, SWING DOORS, SLIDING GLASS DOORS
& OVERHEAD GARAGE DOORS
1. LOCATION/SITE ADDRESS: -i t-orp S . b L LO v. IJ r . t- 12u —�
2. PARCEL ED NUMBER- 352.2 • L20 Z • b0c73 • 000 • 1
3. DESCRIPTION OF PROJECT OR WORK ACTIVITY: A /7 6V/PL. '� �Ef!' f FlL7
4. TYPE OF STRUCTURE: SIR MOBILE HOME OTHER W LL I-F,
5. OWNERS INFORMATION
Name: btvrutcl CAMwa./
Address: —IAgO 5- OLLmtx 1W. tklJ-te
City- State: r —
Zip: _Phone:
6. CONTRACTOWSyINNFORMATION
FL Reg(Cert #: 6 66g35/
County Cert #:
Business /.M&.
Phone Number-5-6 333 9 7//0
Email:, /C/�saC'i lFJu77-.�G.f�4%�//� )e,04
COMPONENT ID.
PRODUCT DESIGN PRESSURE
PRODUCT APPRO VAL #
WINDOWS
3. 12
SKYLIGHTS
SLIDING GLASS DOOR
SWING DOOR
MULLIONS
13 - Of (9-. 0 -
OVERHEAD GARAGE DOOR
[] Attach 2 copies of the Product Approval with details to the product being used.
VALUE OF CONSTRUCTION: $ (j 2-q I-, SZ FEES DUE:
OWNERS AFFWAvrn I certify that all of the information contained in this application is correct and that all work will be done in
compliancewith allMpEcable laws regulating construct Wning
EL7d�
PRINT OWNER OR CONTRAcrowQUALIFIERN_A-ME , SIGNATURE OWNER OR CONTRACTOR/QUALIFIER
STATE OF FLORIDA, COUNTY OF �ft(M nW�.W� p
ACKNOWLEDGED BEFORE ME THIS 7-4- DAY OF &LL V , 20 It- , BY F-11GI &V-Z{ ChW liTY1
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED - - --.._AS IDENTIFICATION.
�ONNIS GOMEZ -
SIGNArrU NOT TYPE OR PRINT NAME O ffi - %COMMISSIONS A96826
9p:� EXPIRES May 23, 2015
TITLE: NOTARY PUBLIC COMMISSION NUMBER 4 FlotlOallotaryService.com
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT.