HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .5 Permit Number:
RECEIVE0 OCT 19'2015
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 — �qr ,� Od
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PRO�OSEDxIMF?ROVEMENT LOCAT IQN....
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Address: I 1Is 'C�1'
Legal Description: iT 11 WAC*fr L46 I, I - OD
Cor 3g3q2,1 - ( b3a)
Property Tax ID#: 0,41.1 —6%UE —00 Q I D® Lot No. J
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back: Right Side: Left Side:
DETAILED DESCRIPTION OgF WORK w
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CONSTRUCTION INFORyM;4TIONr".
Additional work toe er orme under this permit—check a appy:
HVAC F]Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 1 V c7 Utilities:n Sewer O Septic Building Height:
OWNERf LESSEeE CONTRACTOR c "d
i Jack.�B Melton
Name� - .a \ 'f��l,'List Ifs � Name:
AddressJb.��\: ,►I Ii SrA Company: Garage Door Sales,.Inc.
City: "�1`' State: Address:2807 Okeechobee Road
Zip Code: 3 q Fax: City: Fort Pierce State:FL
Phone No. �r d� 1 JAI Zip Code: 34947 Fax: (772)461-8719
E-Mail: VV1�hl� t-1Gi 1 Ut,_l Phone No. (772)461-0729
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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.
SUPPLEMEL CONSTRUCTION LIEN LAW INFORMATION �=
n
�.��. .. p MORTGAGE -,
DESIGNER/ENGINEER: X Not Applicable NY: 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: Pho e:
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 older to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and coven nts that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any estrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all r spects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Ame dments.
The following building permit applications are exempt from undergoing a full concurrency re iew: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses Lo another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may r asult in your paying twice for
improvements to your property. A Notice of Commencement must be record d and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lenc er or an attorney before
commencing work or recording our Notice of Commencement.
S' ature of own er7 Agent/Lessee ig ature of Contr ctor/Li ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �-�' LAA& COUNTY OF Stwde
The for oing instrumen was acknowledged before me The for oing instrument as acknowledged before me
his
tday of 1)e.-Mer 20 lfby this day of lbw 20_1ff-by
k1+e4qr'X— V (Z-nng Katherine V Roznak
(Name of person acknowledging) (Name of person acknowledging)
Y
(S' nature of Notary Public-State of arida (S' nature of Notary Public-State of Florida)py
Personally Known OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Prod ced
Commission No. q mission No. FF0401160
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Revised 07/15/2014
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