HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:v1 �, \� Permit Number: `rsO
RECEI'.":D APR 112016
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 - (G a ��
PROPOSED IMPROVE MENT,LOCATION:
Address: 168 SE SELVA CT
Legal Description: RIVER PARK
Property Tax ID#: 3419-550-0004-000-3 Lot No.8
Site Plan Name: Block No. 62
Project Name:
Setbacks Front Back: Right Side: Left Side:
OPETAILED.DESCRIPTION OF WORK. :"
TEAR OUT AND REPLACE 9 X 6'9" GARAGE DOOR
CONSTRUCTION INFORMATION: .
Additional work toa er orme under this permit—check a appy:
HVAC Ei Gas Tank E]Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 1577.00 Utilities:Sewer Septic Building Height:
b..W, ER/LESSEE CONTRACTOR: {:
Name ROD WRIGHT Name: DENVER MILLER
Address:168 SE SELVA CT Company: D& D GARAGE DOORS PSL
City: PORT ST LUCIE State:FIL Address: 435 NW ENTERPRISE DR
Zip Code: 34983 Fax: City: PORT ST LUCIE State:FL
Phone No.772-800-9223 Zip Code: 34986 Fax:
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 CONSTRUCTION LIEN LW INFORMATION;;
3
DESIGNER/ENGINEER: x_vNot 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 thepermit 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/Agen gnature of Co tractor/ icense Holder
STATE OF FLORIDA 1 STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing instru nt was acknowledg d before me The for oing instru ent was acknowledged before me
this day of �� 20\b by this�day of C 1 ' 20 _L�p by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Vate of Florida) (Signature of Notary,Publ/ic-Sta a of Florida)
Personally Known 1,""'OR Produced Identification Personally Knowny OR Produced Identification
Type of Identification Prloducedl 1 ' ' Type of Identification Produced ll II�
Commission No. �� �O�`4�1 A;� �1) TIFFANY A.LEE Commission No. A�t ; eat) TIFFANY A.LEE
* MY COMMISSION 4 FF 10 474 * MY COMMISSION If FF
r IBES:April 2c.2�1d
BondedThruBudget Notary Services raTFo `ot�`O BondedThruBudgetWuryS rei F
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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