HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 Permit Number: k(;4�-0331
RECEIVrD ASR 18 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 +�
PERMIT APPLICATION FOR: Shutter
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Address: 99 K0
Legal Description: 0 ticIF -7o7-
Property Tax ID#: L(S-0-1- So 2 - oyb4 -Oc7y 5 Lot No.
Site Plan Name: (�A,r® �y \,.�E4yk.+� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itiona wor to e e orme un ert ispermrt-c ec a appy:
HVAC �Gas Tank ❑Gas Piping �_Shutters �Windows/Doors
Electric Plumbing Sprinklers 11 Generator F] Roof
Total Sq. Ft of Construction: I& Sq-Ft.of First Floor:
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Cost of Construction:$ Utilities: _Sewer❑Septic Building Height:ifta
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Name ew Name: Michael Heissenberg
Address: Qq 40 J 0 0-80%N J Company: Expert Shutters
City: c,.s.., OJeA ll State: F-L Address: 1626 SW Biltmore St
Zip Code: 5'1 Fax: City: Port St Lucie State:FL
Phone No. -7'12- ?-K9 -bS%Z Zip Code: 34984 Fax:
E-Mail: Phone No. 772-871-1915
Fill in fee simple Title Holder on next page(if different E-Mail: CAQA(2rttik(E--Arak.
from the Owner listed above) State or County License:r16572
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: x Not Applicable M®RTGAGE COMPANY: X Not Applicable
Name: waicerTiiiit Name:
Address:6355 Nw 3su,st Address:
City: Virginia Gardens State: FL City: _
State:
Zip: 33168 Phone: 305-871-1530 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, r re ording Vouylotice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holde
STATE OF FLORIDA15�-_ Lug. I�� COUN OF OF ORIDA �4, LU C l��
'COUNTY OF
The forgoing instru e t was acknowledge,{before me The f doing instryfrient was acknowledged before me
this 1 !-day of �i I 20 l R by this!=day of I 20 L by
(r) C
(Name of person acknowledging) (Name of person acknowledging)
C)fV V
(Signature of Notary P lic-State of FI i ) (Signature of Notary P7011
State of Flori a
Personally Known OR Produced Identification Personally Known Produced Identification
Type of Identification Produced Type of Identification Produced
Commission NoTT HEIi( bMP VIZZO Commission NR I(oJ 6 y H .VIZZOC
o NOTARY PUBLIC c
STATE OF FLORIDA
Comm#FF176266 'Xl �. omm FF176268
Revised 07/15/2014 sitic 190 Nc ®� Expires 11/13/3018
E Expires 11/13/2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS