HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr�
ALL APPLICABLE INFO MUST BE COMPLETE. ra1R APPLICATION TO BE ACCEPTED
Date:
Permit Number:
JOB' 0773
SCANNED
cj BY
St. LUCIe Cfnlnt%
Building Permit Application aP
Planning and Development Services ,o �2610
Building and Code Regulation Division S �hrg9spa %B
2300-Virginia-Avenue,-Fort-Pierce-FL-34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial A Residential
PERMIT APPLICATION FOR: Window/door III
PROPOSED IMPROVEMENT LOCATION:
Address: 4100 N AIA BLDG. 1 UNIT #113
Legal Description: TREASURE COVE DUNES UNIT 113 (OR 4101-1369)
Property Tax ID #: 1423-502-0003-000-4
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
WINDOW REPLACEMENT
CONSTRUCTION INFORMATION: III
HVAC LJ Gas Tank
Electric 0 Plumbing
r111.-Lnecxa1i
Piping
nklers
apply:
Shutters ❑
Generator
Windows/Doors
Roof = Roof pitch
_
1:1
Total Sq. Ft of Construction: S Ft. of First Floor:
� G
bd
Cost of Construction: $ 06 Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ANNE VALLEJOS
Name: 22FZ_ 'E
Address:4100 N AIAAPT 113
Company: n� � 641146Ew 'uc
City: FT. PIERCE State: FL
Zip Code: 34982 Fax:
Phone No.772-260-9587
Address: 8D&O SD5AA077*e1mil
Lit-,U&
City: Pok-TS-1, ktklE
Zip Code:.3 R&P Fax:
Phone NoCr%%a� �7r(�(p-09/3
77
E-Mail: G� 7RENE�/��� f
Stater
NZ✓J-"
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: erz—
/J
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
J
SUPPLEMENTAL CONSTRUCTIL,LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
—Address.
Address:
City:
City:
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 Countyy 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
Kali 111 } 41 f lei l r�UrIU �:(U [:�KRI[�ll}I�rL�111 \ bU [H��} iR�] 1 it I}La 1i4 711i 711+
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Signature of Owne / Lessee/Contractor as Agent for Owner Signature of Con actor/License Holder
STATE OF FLORIDA STATE OF FIL I A
COUNTYOF $r LUGZ`e COUNTY OFF ZZJ���P
The forFF��o,ing instrument was acknowledged before me The fo-rg,o�'r;-g instru e t as acknowledgeeefore me
thiscN clay of "R I I 20�by this maw of !L --_. by
Name of person% aking statement
Personally Known L/ OR Produced Identification
Type of Identification
Produced
//4&4_
(Signatur of N
"' • t�.: MARY ANN MATONTI
Commission No. _�y_r0MMlsGir{S mot,,,,
EXPIRES January 24. 2020
CA`l�y re teg-P
Name f persoy making statement
Personally Known t/ OR Produced Identification
Type of Identification
(Signature
Com
REVIEWS I FRONT -PNS
COUNTER I REEVIEW NING I S REVIEWOR REV EW
DATE
COMPLETED
Rev.8/2/17
ry Public- State of Florida )
IWAIRY AN N MATOWW
My COMMISSION H FF95313a
EXPIRES January 24 2n2n
VEGETATION I SEATURTLE I MANGROVE
REVIEW REVIEW REVIEW