HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2306 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Add ress
Legal Description:
Permit Number:
Building Permit Application
Commercial Residential_
PropertyTax ID #: Lot No. a_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 1 . . f .
Gas Piping
Sprinklers
Shutters
_ Generator
Sq. Ft. of First Floor: _
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
Namer��j�C— o Name:
Address Company
CityNState: Address:IL
Zip Code:;at Fax: City:
Phone No.] "J Zip Code:
E -Mail: Phone No3�\
Fill in fee simple Title Holder on next page ( if different E -Mail
from the Owner listed above) State or County Licem
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
r -
State:
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 ' h lender or an attorney before
commencin or record in o ce of Commencemen _
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Signatu Owner/ Lesse C6ntractor as Agent for Owner =T�E'01`
of Contractor/License Holder
STATE OF F ` FLQRIDA
COUNTY OF COUNTY OFA
The forgoing instpyment was acknowledged before me
this t-aday of 20Wby
(Name of person acknowledging )
(Signature of Notary Public- SlCate of Florida )
Personally Known ,.-'' OR Produced Identification
Type of Identification _y
Produced a 'r RICK J AACK..iVtl,e,
My CONIMISIQN � FF6; 6
Commission No ,�EXPIR43h,ch J�?
REVIEWS FRONT ZONING
COUNTER I REVIEW
COMPLETED
The f�onrgoing ins ument as acknowledged beforr- me
this i- x day of 20 by
(Name of person acknowledRIr p_.} -----
1 "
(Signature of Notary Public -State of Florida )
Personally Known Y OR Produced Identification
Type of Identification r�,,,._-_..
WCK J PACKENNA,
Commission No.
rX1E�S Marl .5,?O1;
15;3
SUPERVISOR I PLANS VEGETATION SEATURTLE MANGROVE
REVIEW I REVIEW REVIEW REVIEW REVIEW
National Shutter & Aluminum Inc.
Hurricane Protection Systems, Windows, Dorvs Ra!Inys, Screen, fk Pergolas
700 Commerce Wav bVesi
Jupiter. Florida .33,458
561748,8806 Office • 56174E,E9C£ Fax '
Uednaed 3 Insured 11.6C 12536;51-
A+Faring 888
JOB NX MP DATE:
{
,106 AG QRESS.
- - -- JOB:
CITV1AT-ArI:IP
6EVELOPMENT NAME -
1,7.T
CONTACT PERSON:
JOBSITF=P4-XIE: _ .._.__ _^ _IJEkT[tY•I'__� _.--_ __
BILLING AGGRESS:
CITYIST-ATEI?IP'
TELEPHONE.,. I
I ueSCriphon of the site of structure:
G New Site Q'Existinp Building
Power: O Yes O No O NIA
M Single Family Construcuorr.
O Conskurtion ,Q,Blnr,.h
O Townhouse IJ Wood
I fJ Oth er ] 011ie,
No. of S0,rle5
Product Type:
Q ACC tointart
Pafltala rLlc :•n,
20 4 pe 28 qa.l+ L-.
,I; : -,1541 onl nc�l!'
❑ cl5a, panels -
O Olhc,
Aluminum Finish: ,F,,:
O lv&II 0 White Elh,nl v O 8ronz,.. -JBr.lge
COun ty Code: ❑ DAOE Q FI_ Rl-DG CODE
CASH TERNS
Total Price $ -71�
^armil Fee 4(l?._'
I
New Total $ '7 3 5C_; _
Deposit $ t+ /
I Cr Measure It
On Start $
i
On .n Completion $
NSA Use Only'
Complete all information that pertains to job.
O Permit not required Permd raquired
%37L �:% Cis" JU'
'4
Perm 1
1 M ,.,Ilia ._—
••I., =led Survey CI HOA APDroval
'! .,.-:m (Refa,i x3'2,500.001
1' 'row Average Windier
Height 2nd flop,
I
I
SPECIAL INSTRUCTIONS.
Ask about lifetime warranty with extended maintenance contract.
National Shutter 8 Aluminum Inc. ufler:; Yearly maintenance contracts with the purrhasiI or uuv:huBars systems. Included in the maintenance
contract is leaning out all tracks On freckoloa sh iters tM a per ear ami Nhnv li i o s4itin rsystems
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I/We have read both the front, and back of the foregoing proposal contract
and acce pt the same on the terms and conditions printed on the reverse side I I/VJ- ieGeived aSopypt the Consumer Ri ! ppli
and as staled above.r
Quoted price will be honored for 15 days. "�=v - o'ra
Purchaser :' ' F''
CA•PUrfh3:=Er .- � npf?rno-=.0 E'; _.-___.- ___ U
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alrtr er � rn n. r rxr I Nlr rrr I.r rrRnG: lll.li alp - J u0e-1n1ne lrPPil10b0rrti1W5 va O?Irl Te..Mt
MAKE CHECKS PAYABLE TO NATIONAL SHUTTER & ALUMINUM INC.