HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: aG Permit Number: `Cn4Srd� 1�
-' 101 - RECEIVED MAY 2 6 2016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FI.34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Shutter Dao C 5
PROPOSED IMPROVEMENT LOCATION:
Address: 2859 Divine Rd,Fort Pierce,FL 34981
Lega I Descrl pilo n:wn TE CITY SID 05 36 40 W 250 FTOF E 129 ALSO DESC AS W 250 FT OFNW 1/4 OF NE 1/4 LESS RD RS/W-(1.45 AC)(MAP 34/05N)(OR
Property Tax ID#:3403-502-0127-000-3 Lot No,68
Site Plan Name: Block No.
Project Name:John&Nancy Clark
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replacement Doors(2)-)_Yy\Qc C&l-
CONSTRUCTION INFORMATION:
i lona wor to a orme un er is ppg ermit—c ec a appy:
❑HVAC DGas Tank ❑Gas Piping _Shutters Windows Doors
Electric 0 Plumbing []Sprinklers Generator Fl Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ 4,170.00 Utilities:0Sewer Eheptic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name John&Nancy Clark Name:Sam Ochstein
Address: 2859 Divine Rd Company:Newsouth Window Solutions
City: Fort Pierce State: FL Address:2526 Okeechobee Blvd. .
Zip Code: 34981 Fax: City:West Palm Beach State:FL
Phone No. 772-464-2386 Zip Code: 33409 Fax:561-478-4100
E-Mail: Phone No. 561-712-9000
Fill in fee simple Title Halder on next page(if different E-Mail:westpalmbeach(a,newsouthwindow.com
from the Owner listed above) State or County License:CRC1330822
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL cbNSTRUCTION LIEN LAW INFORMATION:
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 certifythat no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting apermit will authorize the permit holder to build the subject structure
which is in confllct with any applicable Home Owners Associatlon 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.
SignatdA of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FU3WDA STATE OF F A
COUNTY OF COUNTY OF kC_>S1
The,f/�rgoing instrument was acknowledged before me The oing instrument was acknowledged before me
this 10 day 20 Eby this day of X51 ,20_�by
(Name of person acknowledging) (Name of person acknowledging}
r
r
(Sign Notary Public-State of Florida} (Slgnat ry Public-State of Florida)
Personally Known OR Pr ed Identification 1�_ Personally Known V OR Produced Identification
Type of Identification Produced Type of Identification Produced
P
Commission No. {SeJQM A. STONE Commission No.
U�jff�My COMMISSION FFF928p06oP EXPIRES;Octobc 15,2019
oars
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS