HomeMy WebLinkAboutBuilding Permit Application Ile
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f /�
Date: 3/18/16 Permit Number: I (�
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
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ERMIT APPLICATION FOR: Window/door
FtOPOSEQ„1111PR011EMENT LOCATION
Address: 4905 Paleo Pines CIR Fort Pierce, FL 34951
Legal Description: Holiday Pines S/D-Phase II-B-LOT 326 (Map 13/13N)(OR 3331-2387;3653-2408)
Property Tax ID#: 1312-801-0129-000-0 Lot No.326
Site Plan Name: Block No.
Project Name: Window Replacement-Grundy
Setbacks Front Back: Right Side: Left Side:
i3 16r 3 i- AsR 6"3 i 1
1L El WORK
Replacement of existing windows with new PGT 5500 impact resistant windows
CNSTtUCTION INFORIVIATizC`N
Additionalwork to be performed under tispermit—check all appy:
OHVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 6295.00 Utilities:CnSewer ElSeptic Building Height:
OUIIN'ER
/LESSEE ONTRACTOR
i Tf 3 j , r S
Name Elaine Grundy Name: Daniel W Beard
Address:4905 Paleo Pines Circle Company: Vero Glass& Mirror
City: Ft Pierce State:FL Address: 1669 Old Dixie Hwy
Zip Code: 34951 Fax: City: Vero Beach State:FL
Phone No.772-489-9990 Zip Code: 32960 Fax: 772-562-1474
E-Mail:ebg0607@aol.com Phone No. 772-567-3123
Fill in fee simple Title Holder on next page(if different E-Mail: danb@veroglass.com
from the Owner listed above) State or County License: SCC131151280
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
5llPPLEMENTAL CONS1Rt1C11QN LIEN LAUUrINFORMATION 3 kf
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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.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.
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Wer/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORA STATE OF FLO WA
COUNTY OF ' X17(It wn �,%lar__ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_�,L day of 20%-(,.,.by this auday of (�CJ b'_JA 20 L2,by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification�_ Personally Known_�OR Produced Identification
Type of Identification Produced rL b2n7 Type of Identification Produced
Commission No. oZ a ission No.�� f S^� (Seal)
KNI60ERLY OE
by.
Notary i6lblls-1""M
31ib M IN�s ",,•,, KIINHERlY.OENNIN
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Revised 07/15/2014 ;;F MY Comm.Expires dMI.2018
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Niy Comm.Expires Jfi12
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