HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `� �°� 115 Permit Number: 50`1- U ►G(o
RECD.TD SEP 0 92015
m _
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 x Residential
PERMIT APPLICATION FOR: Shutter
PROROSED'I1V ROVEMENT�LOCATION,
�.r
Address: 3120 N A1A 101
Legal Description.. TIARA TOWERS UNIT 101-S
Property Tax ID#: 1425-610-0074-000-0 Lot No.
Site Plan Name: Jeffrey A Goldberg Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAIILED DESCRIPTION,OE
Install 2 Accordion shutters
CONSTRUCTION.JNFORMATION ,
Additional work to be nertormed under t ispermit—check—all app y:
❑HVAC 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:$ 6011.00 Utilities:cn Sewer O Septic Building Height: 150'OWNER/LESSEE,-CONTRACTOR:
Name Jeffrey A Goldberg Name: Michael Heissenberg
Address:141 SE Saddle Mountain SE DR Company: Expert Shutter Services
City: Calhoun State:GA Address: 1626 SW Biltmore St
Zip Code: 30701 Fax: City: Port St Lucie State:FL
Phone No.770-547-0706 Zip Code: 34984 Fax:
E-Mail: Phone No. 772-871-1915
Fill in fee simple Title Holder on next page(if different E-Mail: expertpermits@aol.com
from the Owner listed above) State or County License: 16572
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU,PPLEMENTALWNSTRUCTI.�N LIEN LAW INFORMATION:
. , �kw �. .� u
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _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 rdin r Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Hold
STATE OF FLORIDA STATE OF FLORIDA
CO U NTY OF St Lucie COUNTY OF St LUC1e
The forgoing instrument was acknowledged before me The forgoing instrume t was acknowledged before me
this3fO day of `/AR 4 20 Eby this3Yo day of 20 1 c'by
Michael Heissenbtrg Michael Heissenberg
(Name of persgn ackno ledging) (Namf person acknowledging)� /
id-tv C\
(Signature of otary Public-State of Flori ) (Signature of Notary Public-State of Flo )
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced_ .�. YM Type of Identification Produced
' NST Y PUBLIC
Commission No. a j,�� Commission No. i{�, Y � �� ER VI7Z0
-+S OF FLORIDA OTARYPUBLIC
�. Comm#FF176266 Com` 81ATE OF FLORIDA
h'CE 19 Expires 11/13 Comm#FF176266
Revised 07/15/2014 E I Expires 11/13/2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS