HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL IN Of MUSJ_BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' `� Permit Number: `���
e '
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 � -
PROPOSED IMPROVEMENT LOCATION
Address: 6025 TRAVELERS WAY
Legal Description: PALM GROVE
Property Tax ID#: 3410-503-0361-000-0 Lot No.23
Site Plan Name: Block No. L
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION Of WORK
TEAR OUT AND REPLACE 9X7 GARAGE DOOR
CQ=NST:RUCTION:INFORMATION r
Additional work to be nertormed under this permit—c ec all that appy:
HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 959.00 Utilities:0 Sewer Septic Building Height:
OVIf N ERjLESSEE CONTRACTOR
Name KEN BOUDREAU Name: DENVER MILLER
Address:6025 TRAVELERS WAY Company: D&D GARAGE DOORS PSL
City: FORT PIERCE - State:FL Address: 435 NW ENTERPRISE DR
Zip Code: 34982 Fax: City: PORT ST LUCIE State:FL
Phone No.772-489-2468 Zip Code: 34986 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 LAIN INI=50RMATION '
,
DESIGN ER/ENGINEER: RT
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 recording our Notice of Commencement.
_Signature ofOwner/Lessee/Agent Signature o uContractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF `S� ��c�e- COUNTY OF aA--
Thefor oing instr ent was acl nowledged before me The forgoing instrument was acknowledged before me
this�S day of 20 15by this day of 20 by
DENVER MILLERL DENVER MILLER
(Name of person acknowledging) (Name of person acknowledging)
(Signature ZTNbtary Public- tate of Florida) (Signature of Notary Public-t tate of Florida)
Personally Known X OR Produced Identification Personally Known '+' OR Produced Identification
Type of Identification Produced Type of Identification Produced
0" &" TIFFANY A.LEE
Commission No. ��'��»� I)MY COMMISSION 9 FF 10EAommission No. ����\�^l� .�,,4Se�l) TIFFANY A.LEE
EXPIRES:April 26,20 =� �°p MY COMMISSION#FF 1 74
v\11e BondedThruBud etNafe So s
Revised 07/15/2014 f0i0,0""� BondodThruMot NftySe ces
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS