HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `-� \eD Permit Number:
RECEI`.' _D OCT 13 2016
o -
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
PROPOSED IMPROVEMENT LOCATION..,
Address: 2200 N 53rd Street, Fort Pierce, FL 34946
Legal Description: Harmony Heights Addn Blk M Lots 23 and 24 (OR 1200-1607)
Property Tax ID#: 1431-701-0236-000-2 Lot No. 23 &24
Site Plan Name: Block No. M
Project Name: Window replacement
Setbacks Front Back: Right Side: Left Side:
DETA"ICED DESCRIPTION, Of WORK
Replace existing windows with Impact Resistant new ones.
CONSTRUCTION]N FORMATION:
Additional work to be nertormed under this permit—check a appy:
11HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers a Generator F] Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 10,500.00 Utilities:�Sewer Septic Building Height:
OWNER/LESSE.E CONTRACTOR:,
Name Rosanna D. Jackson Name: Jose De La Hoz
Address: 2200 N 53rd Street Company: De La Hoz Builders, Inc.
City: Fort Pierce State: FL Address: 258 Del Monte Rd
Zip Code: 34946 Fax: City: Sebastian State: FL
Phone No. Zip Code: 32958 Fax: 772-589-8127
E-Mail: Phone No. 772-228-9723
Fill in fee simple Title Holder on next page(if different E-Mail: hilda@delahozbuilders.com
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION LIENAAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable/ _ pp 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 r ed and posted on the jobsite
before the first inspection. If you intend to obtain financing, consul ith len or an attorney before
commencing work or recording our Notice of Commencement.
P"U_•-A— :/z L. l — ' C— E4 /-l9 2 13 u r i-9 6<j S
Si ature of Owner/Lessee/Contractor as Agent for Owner Sign a of _e Li ns Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF f ,-10 f441f. COUNTY OF3 .
The for oing instru t as acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 jl�_by this 3d—day ofc�r���� 20 t�& by
&a LL�L_
(Name of pernn acknowledgin (Na rson ackn ledging)
(Signature kt N r ublic- ate Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Ifi ation Personally Known OR Produced Identification
Type of Identification Produced �t� Type of Identification Produced ,0 L{'Q 1Jai b"l3to6 1
Commission No. 100 (Seal) Commission No. (Seal)
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