HomeMy WebLinkAboutBuilding Permit Application RECE1` -7D OCT 2 20116
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Dat 6: -;'G�1� Permit Number: 1�D k 0' �� 1170
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
r_.
PR' P.OStbANPROVEME,NT LOCATION
Address: 12374 PIPER CUB TERRACE
Legal Description: TREASURE COAST AIRPARK LOT 49
Property Tax ID#: 4224-501-0049-000-3 Lot No.49
Site Plan Name: Block No.
Project Name: BIRCH
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK h
REPLACE WINDOWS ANDc;,DOOR WITH IMPACT
l
CONSTRUCTION'IN,FORNIATION ;
Additiona I work toe e Orme under this permit—check a appy:
11HVAC f Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric ❑Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction: $ 24,330.00 Utilities:Sewer Septic Building Height:
OWN'E'R/LESSEE CONTRACTOR
Name -CIre/0,D I,YGV7 Name: WAYNE BURNETT
Address: 12374 PIPER CUB TER Company: FLORIDA HOME IMPROVEMENT ASSOCIATES
City: PORT ST LUCIE State:FL Address: 3044 SW 42 ST
Zip Code: 34987 Fax: City: HOLLYWOOD State:FL
Phone No. Zip Code: 33312 Fax: 954-792-2170
E-Mail: Phone No. 954-792-4415
Fill in fee simple Title Holder on next page(if different E-Mail: PERMITS@FHAPRODUCTS.COM
from the Owner listed above) State or County License: CGC061890
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SllPPLEMENI`AL CONSTRUCTION LIEN LAW INFRMATI�N
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:
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 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 yo ' tend to obtain financing, consult with lender or an attorney before
commencing work or recordi g you Notice of Commencement.
Signature of 11caner/A nt/LesM Si ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF STLUCIE COUNTY OF BRO—RD
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 30 day of I ,20by this_30day of S0 n 20E�2by
V'-t`"X is�ptk WAYNEBURNETT
(Name of p6rsGfi acknowledging) (NamVpers cknowledging)
47
(Signature of Notary Public-State of Florida) (Signature f Notary Public-State of Florida)
Personal[ Ki nown / nR-P-roduc-ed-Identifi�a•tron Personally nown x OR Produced Identification
Type of I ena�fi¢RY on ProgU _,d•t_at~\nl[�li?KIN!; Type of Id ntification Produced
A .�
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