HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 114 Queen Ann Ct
Legal Description: 14/34S/40E
Property Tax ID#: 1414-702=--31-000-5 Lot No. 3
Site Plan Name: Block No. 24
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Installation of accordion shutters
CONSTRUCTION INFORMATION: I
Additional work toa nertormed under this permit—check a appy:
HVAC Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
11 Electric ❑ Plumbing ❑Sprinklers ❑Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 8,749.72 Utilities:Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Blanchard, Roland Name: James Silvia
Address: 114 Queen Ann Ct., Company: Palm Coast Florida Commercial Development
City: Fort Pierce State: FL Address: 505 Beachland Blvd.,#2
Zip Code: 34942 Fax: City: Vero BeachState: FL
Phone No. Zip Code: 32963 Fax: 772-299-1958
E-Mail: Phone No. 772-299-1955
Fill in fee simple Title Holder on next page(if different E-Mail: giovanna@palmcoastshutters.com
from the Owner listed above) State or County License: CBC 1258218
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 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 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.
s
_Signature of Owner/Lessee/Agent Signature of Con ractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,)D j.4 Al '21 Vee COUNTY OF ALZ U6-4,_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of , sir: 20/ by this_77_day of 20 by
(Name of person knowledging) (Name or'
person acknowled
(Signature of tdry Public-State of Florida) (Signature of Notary,Public-State of Florida)
Personally Known V� Ip�d�� Personally Known � OR Produced Identification.
Type of Identification Pr cti �: Type of Identification Pro c
Ems ^ / w Notary Public state of Florida
Commission No. ?s' .....� ,� EX SE t�Qt;tOber 1,2698 Commission No. Giov gad rausal
%14 l�f. 4PJFcIOir�Rv.CO My C r�is wn FF 193077
OExpires 01/26/2019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS