HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: fuufl0C) 21Dn'j 'lS Permit Number: o�
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Building Permit Application Ffa I �nra
Planning and Development Services Perfhltting p
Building and Code Regulation Division St LUMe �ouen,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Residential
PERMIT APPLICATION FOR: Shutter
PROPOSED IMPROVEMENT LOCATION: -- '•
Address: 3702 N HIGHWAY A1A 1103
Legal Description: GRAND ISLE OF NORTH HUTCHINSON ISLAND CONDOMINIUM
Property Tax ID H: 1423-807-0040-000-1 Lot No.
Site Plan Name: Block No.
Project Name: Polinsky
Setbacks Front Back: X Right Side: Left Side:
�_. r... .. .
,�DE'fAIIED E5C DRIPTf N OF t11OORK:
Install 1 accordion hurricane shutter
0HVAC
1-1 Gas Tank
11 Electric
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 3,918.00
JCIIIILL-LIMLK d1l odpply.
aas Piping Shutters
Sprinklers Generator
S Ft. of First Floor: _
Utilities: Sewer []Septic
Windows/Doors
Roof = Roof pitch
Building Height:
OWNER/LE
CONTRACTOR:=;
Name Ronald J Polinsky & Barbara A Polinsky
Name: Michael Heissenberg
Address: 1716 Magnolia CT
Company: Expert Shutter Services
City: Garnet Valley State: PA
Zip Code: 19060 Fax:
Phone No. 610-620-5036
Address: 668 SW Whitmore Dr
City: Port Saint Lucie State: FL
Zip Code: 34984 Fax: 772-871-0990
Phone No. 772-871-1915
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Callexpert@aol.com
State or County License: 16572
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPRI�MENTALCONSTRUCT(dN USN LAV1% CNFORMATION �-
DESIGNER/ENGINEER:
Name: ritecolnc.
_ Not Applicable
MORTGAGE COMPANY:
Name:
x Not Applicable
Ad d tress: 6355 NW 36th St Suite 305
Address:
City: Virginia Gardens
Zip: 33166 Phone:
State: FL
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
x Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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
Signature
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sk WO e COUNTY OF 5* UUC A P
The forgoing instrument �was acknowledged before me The forgoing instrument was acknowledged before me
this 1 day of E r�'—J-20 Iq by this I day of F C 6 20 (C by
Michael Heissenbk9 Michael Hsissenberg
(Name of person acknowledging) (Name of person acknowledging)
dSignature of Nvy Public- State of Florida )
(Personally Known/ 6<- OR Produced Identification
Type of Identification Produced
Haleigh Short
Commission No����aNOTARYPUBLIC
STATE OF FLORID)
8342
Revised 07/15/2014 Expires 5/25/2021
of Nota/y Public -State of Florida )
Personally Known Qiz OR Produced Identification
Type of Identification Produced
Commission No. G3 G �4 Z (Seal)
�1s Halegh Short
b IATE OF FLORIDA
Cantu# GG 148342
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