HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE
COMPLETED FOR APPLICATION TO BE ACCEPTED 1 'n
Date: !�-'� / ��`O SCANNED Permit Number: 1g0U- oS0q
BY
St. Lucie County
� ttEGE1�ED
Building Permit Application uN i9101R
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
PERMIT APPLICATION FOR: Window/door
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: coiG<tL C VT, 81:ry)-4Yr 6 CL(A
170 -4 ". t4ici k.J#t s A(A_ A,P i "r i�i.Tl'ftnl�i
Property Tax ID#: /`)'1 �4 — /(JI —
Site Plan Name: G o ry & L az.
Project Name: & 0 N Z- A L-lizz
Setbacks Front Back: Right Side: LeftSide:
DETAILED DESCRIPTION OF WORK:
Repair second floor wall and install impact windows
pepartmp
per St. eie GountY
Residential
Lot No._
Block No.
L CONSTRUCTIONINFORMATION: III
L_IHVAC L_=J Gas Tank UGas Piping L_IShutters
11 Electric El Plumbing Sprinklers 1:1Generator
Total Sq. Ft of Construction: _ S Ft. of First Floor:
Cost of Construction: $ ;Z rid Utilities: Sewer 0 Septic
Windows/Doors
E]Roof = Roof pitch
Building Height:
OWNER/LES EE:
CONTRACTOR:
Name 0n ?_ it r, Gz
Name: David Marshall
Address: 39 S W 79 A06 y
Company: David B Marshall General Contractor, Inc.
City: W(19v%& I State: �.
Zip Code: , .3 f Fax:
Phone No.--? ? ate^ �gti -- y,>"R6
Address: 14440 Arlington PI
City: Davie State: FI
Zip Code: 33325 Fax:
Phone No. 954-608-3981
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: dmil@att.net
State or County License: CGC 059718
It value of construction is $Z500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
N a me: David Marshall
Address:
Address:
City: State:
Zip: Phone
City: Davio State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address: taanoAdingtonPi
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 Count, 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
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
SiFWure of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF -BZ'c3u:(X�
The forgoing instrument was acknowledged before me
The for Ding instrument was acknowledged l)efore me
this _ day of 20_ by
this day of ,_ r(1v1 20 by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produce
r rBEVERLY 0. MARSHALL
ARM Notary Puhfl� Cl-to of FIMA.
(Signature of Notary Public -State of Florida)
(Signatu = %ubI1orr&ta08 WofsF2W)31
=, �' ;,` My Comm. Expires Jan B. 2021
Commission No. (Seal)
Comm iss nl�bt��""� Bonded through NationalNoftb*
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
rri a rs r+s '3n.e. P} so. r ..w.�q'. "�c +c
.+,u�6 mom" ✓_:',.. +�xa 5ta -'n` sa �
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name: oavtd aemw
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone
City: Dwie
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address: im4ominptonPi
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 N 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
commencing, floor recording vour Notice of Commencement.
I
Signature
as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF j�iA/J7 / - Z ,4 J� COUNTY OF Brc,t c�
The fQrg9ing instr a was acknowledg d before me
thiday of 20V by
Name of persc a mg s atement
Personally Known V OR Produced Identification
Type of Identification
Produced
- ad�2
(Signature of tary Publi Stta of Florida )
Commission No. F 07_5-,e::.%eal) MARTALUIS
MY COMMISSION P FF 93f
EXPIRES: March IS.2C
REVIEWS
Rev.
The forgQoing instrument was acknowledged efore me
this 5 dayof .ViArle- 20_aby
Name of persgn making statement
Personally Known ✓ OR Produced Identificat3_on
Type of Identification
0.
My Comm. Expires Jan S, 2021
3onded Ihrouph National NofaQHillilin
FRONT EATURTANGRO
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