HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO UST B COM LETED FOR APPLICATION TO BE ACCEPTED 7—
Date: d, Permit Number:
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/door El
NRC)POSED IMPROVEMENT LOCATION 5 3
Address: H46 "Drl�
Legal Description:,OyirAt COUP 12: on Me, blik LOO oft 3,106 fS�l
Property Tax ID#: � 612-20 -601) – $ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION 01F�U1/�C?RK .._ . . . .
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CON�TRlJCT10I� INFORMATION � _ s �� ���-� �_
it onal work to be nerlormed under this permit–c ec a appy:
EIVAC Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑Roof
Total Sq. Ft of Construction:_ S . Ft. of First Floor:
Cost of Construction: $ oZ y5 UtilitiestSewer❑Septic Building Height:
OWNERjLESSLE �s�` CONTRACTOR � � � NMI,' d
_�z r
Name.Edward L.jsamdra P- �1 _ Name: Jack B Melton
Address Rh 13. N bft4e✓'Man 12 n tti Company: Garage Door Sales, Inc,
aty v5 .!�r► d7� ��f ''� State Address: 2807 Okeechobee Road
ZipCode:_ _ Fax: City: Fort Pierce State:FL
Phone No. 4S�JS6,5q 80 Zip Code: 34947 Fax: (772)461-8719
E-Mail: Phone No. (772)461-0729
Fill in fee simple Title Holder on next page( if different E-Mail: kat@garagedoorsales.net
from the Owner listed above) State or County License: County Cert: 4526
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.'
SUPPLEMENTAL CONSTR°UCT10N LfE,N LAW INFORMATION::
pp .
DESIGN
jER/ENGINEER: x Not Applicable MORTG 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 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.
�v
Sig wn r ig a
)Vent/Lessee ture of Contra cto License Holder
ST E OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF Stwae
The for oing instrument was acknowledged before me The forgoing instrunt was acknowledged before me
this—day of u li U 20 16'by this '*-day of Q L4 ( H 2O_LCby
U Katherine V Roznak
(Name of person acknowledging) "G (Name of person acknowledging)
V-
( ignature of Notary Public-5tate#f Florida) ( gnature of Notary Public-State of lori )
Personally Known_ X, —OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
b� 0 Commission No. FFoaoosoTir1ERIC�iE6,.RCZiV
Commission No. 's�`� �P (Seal)
r4Ve_ �'
COMMISSION#F104
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS