HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3� ,� Permit Number: 1 513 6 - 0 �_o
RECEIVE-0 JUN 3 0 2015
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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 Residential X
PERMIT APPLICATION FOR: Window/doom-� -
PROPOSED IMPROVEMENT LOCATION
Address: 6102 PALMETTO DR
Legal Description: INDIAN RIVER ESTATES
Property Tax ID#: 3402-607-0105-000-2 Lot No.18&19
Site Plan Name: Block No. 18
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONLOF WORK: "
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TEAR OUT AND REPLACE 162 X 7 GARAGE DOOR
CONSTRUCTION INFORNI4TION
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Additional work toe e orme under this permit-check a appy:
HVAC E]Gas Tank []Gas Piping _Shutters Windows/Doors
11 Electric 1:1 Plumbing Sprinklers E Generator 1:1 Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 2457.00 Utilities: Sewer E]Septic Building Height:
OWNER/LESSEE :CONTRACTOR: .
Name THOMAS HAGERMAN Name: DENVER MILLER
Address:6102 PALMETTO DR Company: D&D GARAGE DOORS PSL
City: FORT PIERCE State:FL Address: 435 NW ENTERPRISE DR
Zip Code: 34982 Fax: City: FORT PIERCE State:FL
Phone No.772-489-1826 Zip Code: 34981 Fax: 772-460-7635
E-Mail: Phone No. 772-460-7630
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 19007
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION '
DESIGNER/ENGINEER: x Not Applicable _ MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x Not Applicable
Name: Name:
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 thepermit 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 recordin&your Notice of Commencement. _
7
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF STLUCIE COUNTY OF STLUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,Da day of 7Qr,'-- 20 .L�y this 22 day of JUNE 20 16 by
DENVER MILLERL DENVER MILLER
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publi&State of Florida) (SignatureZ1 Notary Public- tate of Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. FF101474 (Seal) Commission No. FF101474 Ryj,,�eal)
o Rv PUF�'o TIFFANY A.LEE TIFFANY A.LEE
* MY COMMISSION#FF 101474APP'199 PAIR * * MY COMMISSION#FF 1014
Revised 07/15/2014 A�FoFF���\oP SondedThruBudgetNotaryServlcea _19rFOFF"�qt:VDIMQ-Anril 9A 901
1 BondadThruBudget Notary Sark,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS