HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 23� SCANNED Permit Number:
BY
SYM_ ,ice,;- St. Lucie County
Building Permit App
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
PERMITTYPE:ReplaCe rear Sliders
PROPOSED INPROVEMENT LOCATION:
Address: 9500 S. Ocean Dr unit 1401
Property Tax ID #: 4502-602-0125-000-3
Site Plan Name:
Project Name: Gortian
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: _
Cost of Construction: $ 25,000
Sq. Ft. of First Floor:
JAN 2 9 2019
ST.
Residential x
Utilities: _Sewer _Septic
Lot No.
Block No.
/�Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE`
CONTRACTOR:
Name Michael & Denise Gortain
Name: Jeffrey Walsh
Address:9950 S. Oceand Dr. Unit 1401
Company: Liberty Home Builders, Inc
City: Jensen Beach State: _
Zip Code: 34957 Fax:
Phone No.
Address:257 SE Monterey Rd
City: Stuart State: FL
Zip Code: 34994 Fax: 772-324-8578
Phone N0772-324-8277
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailconnor@libertyimpactwindows.com
State or County LicenseCGC 1504157
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. Ctp!
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I
I, SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: 45
Name:
_
Address: V
Address:
City: ®
State:
City:
State:
Zip: ,.sue Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY:
Applicable
Name:
Name:
_Not
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
commencing work orlecorAtrls vaw Notice of Commencement. — le--)
re of w er/ Lessee/Contractor as Agent for Owner
gnature f Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The for oing instru ent was acknowledged before me
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The forgoing instrument was acknowledged before me
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Name of person making atement.
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Personally Known V/OR Produced Identification
Type of Identification
Type of Identification
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REVIEWS
FRONT
PLANS
VEGETATION
SEATURTLE
MANGROVE
ZONING
SUPERVISOR
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 9/Zb/18