HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ii /'� �p
Date: 6/23/2016 Permit Number: 1 U V 4
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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: window/door
Address: 6102 TANGELO DR
Legal Description: INDIAN RIVER ESTATES UNIT 09
Property Tax ID#: 3402-610-0402-000-04 Lot No. 15
Site Plan Name: Block No. 84
Project Name:
Setbacks Front Back: Right Side: Left Side:
am
TEAR OUT AND REPLACE 16X7 GARAGE DOOR
-Xdditional work to e nertormed under this permit—check an appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers F]Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ 1560.00 Utilities:Sewer Septic Building Height:
IN
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Name RHA 2 LLC Name: DENVER MILLER
Address:3505 KOGER BLVD SUITE 400 Company: D& D GARAGE DOORS PSL
City: DULUTH State:GA Address: 435 NW ENTERPRISE DR
Zip Code: 30096 Fax: City: PORT ST LUCIE State:FL
Phone No.561-563-2848 Zip Code: 34986 Fax: 772-460-7635
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.
DESIGNER/ENGINEER: x Not 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 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 ur Notice of Commencement.
S
_Signature of Owner/Lessee/Agent Sig ture of Contra or icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST LUCIE COUNTY OF ST LCuIE
The for oing instrument was acknowledged before me The for oing instrument was acknowledged before me
this for
of��AX��. 20 �poy thisa�ay of�VC>"C_ 20 by
DENVER MILLERI DENVER MILLER
(Name of person acknowledging) (Name of person acknowledging)
Q6,c�) -w '4_� 1 0 JQL
(Signature of Notary Public-State of Florida) (Signature o otary Publi State of Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced�l Type of Identification Produced
Commission No. ��,�,�2° YP�e`�(Seal) TIFFANYA.LEE Commission No. �� ��'��,2 a:( I) TIFFANY A.LEE
* * MY COMMISSION#FF 101474 * * MY COMMISSION#FF 101
EXPIRES:April 26,2018
4TFoF Foo onded Thru Budget Notary Services �9'FOFFIo��� Bonded Thru Budget Notary Servi
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS