HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1Ia1 1 I<a Permit Number:
RECER'rD JAN 2 7 2016
........... _.
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
PRi�f?OSEQ IMPp"J,IVIENT LOCATION
Address: 661 PONYTAIL LANE
Legal Description: PALM GROVE
34tio
Property Tax ID#: -349-503-0166-000-3 Lot No.29
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D TAtI:ED DESCRIPTION OF1 OR'
TEAR OUT AND REPLACE 9X7 GARAGE DOORS
CONSTRUCTIC)N INFORMATION
, .. .�. a
Additional work toa oeFormed under this permit—check a appy:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
11 Electric ElPlumbingSprinklers 0 Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 1120.00 Utilities:cnSewer Septic Building Height:
Ot NIrRR"/LESSEE, CbNTRACIOFt:
Name RUDI KROGGEL Name: DENVER MILLER
Address:661 PONYTAIL LANE 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.460-1881 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:
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.
SUPPLEMENT IL CONSTRtJC7ION LIEN LAW N,IRORIVlAT1�N
DESIGNER ENGINEER: _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
ignature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLO4 STATE OF� a� COUNTY OF nA
COUNTY OF
Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this V\ day of 7�0_r-, 20N\�D by this a�-day of7S�'-*- � 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public State of Florida) (Signature o otary Public State of Florida )
Personally Known L,"'e OR Produced Identification Personally Known L"*) OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ��lV��—)�a�tp4( 'arl) TIFFANY A.LEE Commission No. F'E0t f 1q,,R;P�(s�S�eal) �FFANYA.LEE
MY COMMISSION 8 FF 1 1474 * MY COMMISSION# E 1014
EXPIRES:April 26,2 18 is
OFF Bonded Thru Budget Notary Services j4" `d
26,2018
Revised 07/15/2014 FOF FLO°P Bonded Thru BudgetNotary Servide,
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS