HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �a tiro 5 Permit Number:
' tsEC ICED DEC 16 2015
ui�amg 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: Q rnda�J
;PR(1 bS':ED-IMPRQ;VEMENT,-LOCATION ;
Address: 4808 MYRTLE DR,FT. PIERCE,FL 34982
Legal Description: - — -
Property Tax ID#:3402-608-0149-000-5 Lot No.
Site Plan Name: Block No.
Project Name:SMITH, SHALONDA
Setbacks Front Back: Right Side: Left Side:
IN
DETAILECI DES C{ I I W', K
Replacement Windows
CtNSTR`UCTIQN INFORMATION = '
_ -
Additionalwork toa er orme un er this permit-c ec a appy:
E]HVAC Gas Tank ❑Gas Piping _Shutters ®Windows/Doors
11 Electric ❑.Plumbing []Sprinklers 1:1Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 7,892.00 Utilities: Sewer Septic Building Height:
OV1tNER%LESSEE ,y »''' CONTRACTOR. '
Name SMITH, SHALONDA Name:Sam Ochstein
Address: 4868 MYRTLE DRQ: Company:NewSouth Window of West Palm Beach
City: FT.PIERCE- State: FL Address:2511 WESTGATE AVE SUITE 11
Zip Code: 34982 Fax: City-."West Palm Beach State:FL
Phone No. Zip Code: 33407 -..Fax:561-478-4100
E-Mail: Phone No. 561-712-9000
Fill in fee simple Title Holder on next page(if different E-Mail: westpalmbeachAnewsouthwindow.com
from the Owner listed above) State or County License:CRC1330822
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL,CDNSTRU.CTIUN LIEN LAW INFORMATION.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: 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. Lucle 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.
ignature of Owner/A Agent/Lessee Signature of Contra r/Lic s o r
STATE OF FLORIDA a(�. p� f STATE OY FLORIDA
COUNTY OF "f (:I'l, 4G1/
The forgoing instrument was acknowledges 6--fore me The forgoing instrument was acknowledged before me
this day of WAV P.W_be- - , 20-t_by this day of NDV&ube li z0 by
(Name of person acknowledging) (Name of p rson acknowledging}
(Signature of Notary Public-State of Florida} (Signatu a of Notary Public-State of Florida}
Personally Known OR Produced Identification V Personally Known OR Produced Identification
Type of Identification Produced _pkyz •S L�L'&� Type of Identification Produced
Commission No. (Seal) Commission No. wP K1MWe9TONE
My COMMISSION#FF928006
FMIRES:Oct&=15,2019
My COMMISSION#FF928006
Revised 07115/2014 �+a EXPIRES:oMbcr 15,2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS