HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I"1 bra Permit Number:
R E C E I'.' D APR 0 7 20116
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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: Shutter
Address: 179 Mediterranean BLVD
Legal Description: ST LUCIE GARDENS 26 36 40 THAT PART OF BLKS 1 AND 2 LYG ELY OF US#1 AS SHOWN IN OR 2389-720 BEING LOT 179 MEDITERRANEAN N
Property Tax ID#: 3426-500-1074-000-8 Lot No.179
Site Plan Name: Lee A Smith Block No. 1&2
Project Name:
Setbacks Front Back: Right Side: Left Side:
D `AILED ON,`OF WO' r
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Install 1 Roll Up Shutters C'-
"T CTI' INFOR�UTAT[ON
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Additional work toa er orme under this permit—check a appy:
HVAC Ei Gas Tank Das Piping Shutters Windows/Doors
11 Electric ❑Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 1630.00 Utilities: Sewer Septic Building Height: 140
C}\tUNERLSSE'� � .5...c� rONTRACTt3R T3 fi:A f
Name Lee A Smith Name: Michael Heissenberg
Address:179 Mediterranean BLVD Company: Expert Shutters
City: Port St Lucie State:FL Address: 1626 SW Biltmore St
Zip Code: 34952 Fax: City: Port St Lucie State:FL
Phone No.973-714-1558 Zip Code: 34984 Fax:
E-Mail: Phone No. 772-871-1915
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 16572
If value of construction is$2500 or,more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUI'„TIQN LIEN LA1/1/ INFQRMATIC?N z
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DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: _Not Applicable
Na*Wr Name:
Adth Address:
Cit Stat . FL City: State:ZipPhone: 3��o 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 ordof-r`ec1,Fdi`ii'Ryour N91,ice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA —
COUNTY OF f
A L C )t COUNTY OF L u 1 r
The for oing instru vent was acknowledged before me The forgoing instru ent was acknowledged before me
this �Iay of 20 Eby thislfi h day of i 20 16 by
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(Name of person acknowledging J (Name of person acknowledging)
(Signature of NotaryPub'c-State of Florida (Signature of Notary P70R
r' a
-State of Flo ) —
Personally Known OR Produced Identification Personally Known Produced Identification
Type of Identification Produced Type of Identification Produced
� ����� ��gPRy�f HEATHER VIZZO
Commission N0�`�"(� -)��� of HEATHER VI ��
Ctommission a� I�IOTARY PUBLIC
0 NOTARY PUBLIC « ESTATE OF FLORIDP}
STATE OF FLO RIDA
Comm#FF176266 'CE IP Expires 11/13/201
Revised 07/15/2014 "NCE 19�� Expires 11/13/2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS