HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/12/17 SCANNED Permit Number: I 11 2_1 01-P)
BY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x
DEC 2 8 2017
PERN11TTl,',lG
Residen ia
Stt.L,jcie County, FL
I PERMIT APPLICATION FOR: Window/door III
I PROPOSED IMPRQVEMENTLOCAT,,ION:--
Address: I �
Legal Description:
Property Tax ID #: 2212-411-0002-000-3
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
['DETAILED DESCRIPTION 00 WORK. '-'-','
TEAR OUT AND REPLACE16X14 ROLL UP DOOR
Lot No.
Block No.
[CONSTRUCTION
2
Xa�iti8n-alworKtoDenerformea
unaerfrus permit— cneCK
aii apply:
E]HVAC
El
Gas Tank DGas
Piping
Shutters
ZWindows/Doors
11 Electric
ElPlumbing OSprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
S'c Ft of First Floor:
Cost of Construction:
$ Utilities'.
newer
OSeptic
Building Height:
"OWNERILF551EE:
-CONTRAcTOR:'.'
Name
Name: \\rx
Address:
Company: D & D GARAGE DOORS PSL
City: State: EL
Zip Code: Fax:
Phone No. 460-9040
Address: y-D,5 _6 Ek
City: ?<xA— S--Uxc2\f—' State: FL
Zip Code: 34986 Fax:
Phone No. 460-7630
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail:
-TIFFANY@DDGARAGEDOORSPSL.COM
State or County License: 19007
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SURPL'EMENTAL-'CONSTRUCTION LIEN-LAWyINFC1RMATION.
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 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 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
commencingwork or recordingour Notice of Commencement.
D 74
0 .es
Rev. 8/2/17 li
ture of Owner/ es a Contractor as Agent for Owner
Signature of Contractor License Holder
STATE OF FLORIgqA
COUNTY OF fit—
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
The for Ding ins ment was acknowledged e� re me
this day of �'r�bC�. 20� by
this \� day of 20 t b
?
Name of person making statement
✓
Name of persorymaking statement
✓✓
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
�����J\h-� �
(Signature of Notary Public - St to ofz4'iprii%) TIFFANY A. LEE
(Signature of Notary Public- State of Florida )
* � MY COMMISSION R FF 1
Commission No. F�V0\y1y EXPIRES: April 26,2I�
1474 �anr au
n ; .,,e<� TIFFANY A. LE
No. FF\rJ1�4�7�(
BonezdmmBuegattlotaryse
4Id=ommission �@a�,)MYCOMP+IISSION#FF
EXPIRES: April 26,
j'raa ;�oP° Bonded T�.m ButlgdrJohry
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED