HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: n Permit Number: I
••
ECEIV ED
Building Permit ApplicatNesidential '
t-
Planning and Development Services OCT 2 4 2016
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X
PERMIT APPLICATION FOR: Shutter
yP,R�PC►SED 1MPRQ1/Elt'IIENT LOCATION r � ' �, �
Address: 4400 N Al A 12N
Legal Description: PARAGON UNIT 12N
Property Tax ID#: 1423-610-0020-000-1 Lot No.
Site Plan Name: Robin A Mazda LLC Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DERIPTIONF WORK k
Install 1 Accordion Shutter
CONSTRUCT,, 1N iNFAdditionalORMAT[ON
, ❑HVAC or to �e Gas Tank rtormed under this —checka �_
❑Gas Piping Shutters Wind❑ ows/Doors
11 Electric ❑Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
3172.00 I
Cost of Construction:$ Utilities: _Sewer❑Septic Building Height:
auuNRILEslw � pc®NTRACT( R a 4
Name Robin A Mazda LLC Name: Michael Heissenberg
Address:4400 N Al 12N Company: Expert Shutters
City: Ft Pierce State:FL Address: 668 SW Whitmore
Zip Code: 34949 Fax: City: Port St Lucie State:FL
Phone No.772-388-6235 Zip Code: 34984 Fax:
E-Mail: Phone No. 772-871-1915
Fill in fee simple Title Holder on next page(if different E-Mail: callexpert@aol.com
from the Owner listed above) State or County License: 16572
1f value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INF{ RMAT[ON
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ aw,
Not Applicable
Name: walter"rillit Name:
Address:6355 NW 36th St Address:
City: Virginia Gardens State: Fl_ City: State:
Zip; 33166 Phone: 305-871-1530 Zip: Phone:
FEE SIMPLE TITLE HOLDER: X 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 thepermit 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 too in financing, consult with lender or an attorney before
commenci ork or r in ur Noti Commenceme
s
_Signature of Owner/Lessee/Agent Sig ure of Contrac r/Licens older
STATE OF FLORIDA \ STATE OF FLORIDA
COUNTY OFJ L�l COUNTY OF
The for ping instr ment wa ac<nowledged,�efore me The forg��o.i�,n� g instrrm nt wapa knowledged before me
thks!:day of 20 Lby thi0�iay of lJ '� 20 by
Michael Heissen49 Michael Heissenberg
(Name of person acknowledging) (Name of person a knowledging)
zz��o ev
(Signature of Notary:70R
-State of to iv/ (Signature of Notary Pu lc-State of Florid
Personally Known Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification
Produced
Commission NJTI 7�Da(p�otRy4Sea1NEATHER VIZZO Commission No.-EF �GaG�,-% y.4� S THER VIZZO
4 sP�NOTARY PUBLIC QR n NOTARY PUBLIC
STATE OF FLORIDA
0E Fl ORIDAI Cantu#FF176266 'P4 W� Comm#FF176266
Revised 07/15/2014 "%%Y...... Expires 11!13!2018 ����19� Expires 11!13/2018
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DATE
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