HomeMy WebLinkAboutAPPLICATION FOR REPLACMENT OF WINDOWSPLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Fort Piece, FL 34982 SC /VNFO
(772)462-1553
APPLICATION FOR REPLACEMENT OF 4w1@ COUn
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WINDOWS, SKYLIGHTS, SWING DOORS, SLIDING GLASS DOORS
& OVERHEAD GARAGE DOORS
1. LOCATION/SITE ADDREI
2. PARCEL ED NUMBER:
3. DESCRIPTION OF PROJECT OR WORK ACTIVITY: RE%�L/9GG 7il 9
Gae"VCE' �ob25' /Kc foeLihe'
4. TYPE OF STRUCTURE: SFR X MOBILE HOME OTHER
5. OWNERS INFORMAT`ION ' 6.
Name:{11ARke�TG{�pN:c �i��-mllval£R
Addr``e``ss: 5Gi17 ,w'�i 2.S �DrDA lx�_
City:y�Vk& nz 3SIA State: ( ,
Zip: WA c1 , Phone: 41J11•SN-1W
Email:
CONTRACTOR'S INFORMATION
FL Reg/Cert #: . //*. '
CountyCert#: ` 17 3 AA y
Business Name P,9AS4Z4VDt1STQAQr1cra'ZaS
Phone Number, b nq - Uti
Email: tY\sxy o t E G Flol. com
_COMPONENT ID.
PRODUCT DESIGN PRESSURE
PRODUCT APPROVAL # °
WINDOWS, .. «.:..
SKYLIGHTS
SLIDING GLASS DOOR
SWING DOOR .
MULLIONS
OVERHEAD GARAGE DOOR_
IVOR NO.
[]' Attach 2 copies of the Product Approval with details 'to the product being used.,
`, ... .. h
VALUE OF CONSTRUCTION: $ 2.7. ' fed VEE'S DUE:
OWNER'S AFFIDAVrr: I certify that all of the information contained in this application is correct and that all work will be done in
compliance with all applicable laws regulating construction and oni .
OER OR410N& 'ORIQUALIFIER NAME SIGNATURE O� R CONPrACTORIQUALIMR
t _
STATE OF FLORIDA, COUNTY OF 6'Y . W) e ,\ P
ACKNOWLEDGED BEFORE METHIS 30 DAY OF4'kR—t 20 ` ? BY Vr4C {C %; 4,
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED WD.tM—SS43-SI-I '� DEANNA GI
o a "�N�b?3d41N• Stale of Florida
�a �n�nw G w�.Y�S�' ' • _ My Comm. Expires Dec 16, 2016
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOT
CoAion # EE 858761
,�{{ •''.'„�; ;;P Bonded Through National Notary Assn.
TITLE: NOTARY PUBLIC COMMISSION NUMBER
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT. 1" 0
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ST. LUCIE COUNTY
Vinyl Siding
INSTRUCTIONS
Please complete all information in the space provided: All. information must be Printed (use black or blue ink only) or Typed.
This application for replacement of Windows, -Skylights, and Doors'is to be used only for those activities that are not otherwise included
under a primary building permit., This application for Permit may, not be used for any activitythat includes any type or kind of structural
alteration. Building activities involving structural: Iteratiay in addition to the replacement of Windows, Skylights, Doors &Overhead
Garage Doors, must be permitted through the regular building permit review process. The information to be provided with this application
includes:
1. LOCATION/SITE ADDRESS:
2. PARCEL ID NUMBER
3. DESCRIPTION OF PROJECT ORWORK ACTIVITY........
Indicate the street address, or general location; of the property on
which the building activity is taking place.
, , • r'
Indicate the Property Tax Identification Number for the property on
which the building activity is taking place.
Briefly describe the building activity under permit application.
4. OWNERSINFORMATION: ................................I................ Indicate the name and address of the owner ofthe.property on which
the product is to be installed
5. CONTRACTORS INFORMATION-"...': ................................. Indicate the State of Florida (if applicable) and St Lucie County
contractor's registration numbers, -and the name of the business
doing the work.
6. VALUE OF CONSTRUCTION:.:...;:. c................................ Indicate the total value of the work to take place. Total cost of
'A :construction includes all material and labor cos[s associated with the
buildinW000struction activity. The value of_constru6tion is used to _
determine the amount of permitting fees to be assessed: - St: Ldcie
County reserves the -right -to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures
are not consiitent with similar types of construction.
All applications for Permits are to be submitted to the St Lucie County Building and Zoning Department, St. Lucie County Administration
Building, 2300 Virginia Avenue, Fort Pierce, FL 34982. All applications for Permits must be completed and filed with the Department no
later than 4:30 P.M: each business day. No applications will be accepted for processing after 4:30 P.M: For assistance in completing
this application, please contact the St LuciaCgdnty Building and Zoning Department, at (772) 462-1553, during regular office hours (8:00
AM - 5:00 PM), Monday through Friday.'
Following the issuance of this Windows, Skylights, Doors & Overhead doors replacement Permit, the scheduling of all r'equired inspections
maybe made by calling (772) 462-1261.
- SLCCDV FORM NO: 006-05
Revised; 4/102012 PDSD JC
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