HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST RE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 �J Permit Number: _n
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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: Other
R,ROPOSED IMPROVEMENTIO ATION
Address: 2994 Conifer Dr
Legal Description: Hole in one circle Lot 4(0 56 AC (OR 3702-2211)
Property Tax ID#: 1327-803-0004-000-00 Lot N0.4
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:DESCRIPTION OF WORK
REPLACEMENT OF EXISTING 16 X 7 GARAGE DOOR
- 5
CONSTRUCTION f;NFORNIgT1ON
Additional work toe p performed under this permit—c ec. a appy:
HVAC 13 Gas Tank Gas Piping Shutters ❑Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 1300.00 Utilities:i Sewer E]Septic Building Height:
-OWNER/LESSEE.: CONTRACTOR:
Name CHUCK RARICK Name: ADAM DERIENZO
Address:2994 XCONIFER DR Company: ANCHOR GARAGE DOOR REPAIR LLC
City: FORT PIERCE State:FL Address: 921 SW MCELROY AVE
Zip Code: Fax: City: PORT SAINT LUCIE State:FL
Phone No.561-414-7329 Zip Code: 34953 Fax: 888-615-7171
E-Mail: Phone No. 772-626-5799
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
in
of construction is$2500 or more,a RECORDED Notice of commencement is required.
SU,P;PLEIVIENTAL CONSTRUCTION LIEN LAIN,INFORIVIATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _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.
s
_Signature of Owner/Lessee/Agent Si ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF L
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The f LWnstrument was acknowledged �e ore me The f r of_. instrument w s acknowledged re me
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(Name of person acknowledging) (Name of person acknowledging)
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Personally Known OR Produced Identification V Personally Known "q' � a tification
Type of Identificati PWdu�e Type of IdentificatiGr
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Revised 07/15/2014 � -
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