HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I C;?• Permit Number: 15,1d,
RECEIVEL
Building Permit Application DEC 16 2015
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
J
PROPOSED IIVIPRO.VEMENT LOCM-ION `h
Address: 5313 Palmetto Dr
Legal Description: Indian River Estates
Property Tax ID#: 3402-606-0053-000-9 Lot No.55&56
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED aESC RIPTI"ON tF W ?RK
b
Tear out and replace 16x7 garage door
CONSTRUCTION INFORMATION '
Additional work to a er orme under this permit—check all appy:
HVAC Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 1520.00 Utilities:n Sewer Septic Building Height:
OWNER/LE55E =
"to "TA
a
Name Mary Toler Name: Denver Miller
Address:5313 Palmetto Dr 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.772-579-1140 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: Tiffany@ddgaragedoorspsl.com
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 CQNSTRUCTl0N LIEN LAW INQRMATlQi ,
.. " >. .
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
CO U NTY OF St Lucie CO U NTY OF St Lucie
The forgoing ins ument was acknowledged before me The forgoing instrument was acknowledged before me
this day ofeclb�, 20 F,_ by this I"kday of20 NS by
Denver Miller 1 Denver Miller
(Name of person acknowledging) (Name of person acknowledging�k 'A qi�
)
(Signature o otary Public-State of Florida ) (Signature o otary Public-Sate of Florida )
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
o'NRY PUB TIFFANY A.LEE Rv Pu
Commission No. FFioia�a ag ) commission No. FF�o�a�a os;...,B��eal) TIFFANY A.LEE
* * MY COMMISSION#FF 10 474 ? .
EXPIRES:April 26,20 8 x * MY COMMISSION#FF 101474
s EXPIRES:April 26,2018
FOFFlA ATFOF P�O�\ Bone fU UOQO 0
Revised 07/15/2014
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