HomeMy WebLinkAboutBuilding Permit Application �N�
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I�
Date: Permit Number:A�� )• 03�
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
PERMIT APPLICATION FOR: Window/door
PROPOSED'IMPROVEMENT LOCATION:
Address: 5704 Cassia Dr, Fort Pierce, FL 34982
Legal Description: Indian river Estates-Unit 09-BLK 80 LOT 1 (Map 34/12N)(or 549-1905)(or 552-2500:2312-2556)
Property Tax ID#: 3402-610-0292-000-9 Lot No. 1
Site Plan Name: Block No.
Project Name: Schmidt
Setbacks Front Back: Right Side:' Left Side:
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C«ONSTRUCTI®N INF®RKMATI®'N:
Additional work to be nertormed under tispermit—check all appy:
HVAC Gas Tank E]Gas Piping _Shutters Q Windows/Doors
' i
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
t
Od
Cost of Construction:$ 3�� • s: _Sewer 0 Septic Building Height:
Uilitie
®1NN ER/LESSEE: CONTRA+CT®R:
Name Grace T Schmidt Name: Richard A Shores
Address:5704.Cassia Dr Company: Folding Shutter Corp
City. Fort Pierce State: FL Address: 7089 Hemstreet PI
Zip Code: 3498? Fax: City` West Palm Beach State:FL
Phone No.;772'882-1160Zip Code: 33413 Fax: 561-640-8204
E-Mail: Phone No. 561-683-4811
Fill in fee simple Title Holder on next page(if different E-Mail: info@foldingshutters.com
from the Owner listed above) State or County License: SCC131151222
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S�UP.P:LEME'NTAL"CONSTRUCTION LIEN LA1N;'INF�ORMATI®N� � ,; �r
9
DESIGNER/ENGINEER: 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 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 Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Po-kL BeacAr\ COUNTY OF Palm Beach
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2-1 day of 0 I 201�iby this 2.I day of 20 1 Eby
Richard A Shores
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known 1C/ OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Producedc ��
Commission No. ��(5b �6 !�J (Seal) Commission No. F�f 5_b /(I7MELArSXR-aE'VANS
NRYq PAMELA A.EVANS 4
_rM ssoo NOTARY PUBLIC °A' ' NOTARY PUBLIC
o STATE OF FLORIDA A Comm#FF150967
Revised 07/15/2014 �s�k F ig10�Comm#FF150967 a .-i �®
Expires 0 Expires 10/11/2018
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