HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 f? Permit Number:
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Building iI
Planning and Development Services
i' Building and Code Regulation Division
1300 Virginia Avenue, fort Pierce Ft 34982
Phone; X772; 462.1553 Fax: 1772; 462-1578 Commercial, Residential
PERMIT APPLICATION FOR:
Window/door
'PROPOSED IMPROVEMENT LOCATION: 1
Address 5789 Travelers Way, Fort Pierce, FL 34982
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Side:
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OWNERA SEE:
Name Paul & Maria McDaniel
Address 6031 Adonidia PL
City; Fort Pierce
Zip Code: 34982 Fax:
Phone No, 772.466-1827
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Windows/Doors
E® Roof El Roof pitch
Building Height:
CONTRACTOR:
Name: Kevin R. Matyjaszek
Company; Excelsior Construction & Roofing
State: FL Address:1882 SE Crowberry Drive
E -Mail: Phone No, 772-418-8809
Fill in fee simple Title Holder on next page (if different E -Mail: info@excelsiorconstruction.net
from the Owner listed above) State or County License: CGC1521911
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SUPPLEMENTAL CONSTRUqON LIEN LAW INFORMATION:
DESIGN ER/ENG IN EER: Not Applicable NDff,,&jft
Name:
Address:
City:
Zip: Phone:
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FEE SIMPLE TITLE HOLDS
Name:
Address:
City:
Zip: Phone:
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Nat Applicable
Name:
Address:
City:
Zip: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit,
/Not Applicable
61101111
iNot Applicable
St, Lucie Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contiict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure, Please consult with your ;come Owners Association and review your deed for any restrictions which may apply,
Ir> 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
before the first inspection, If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement,
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Signature of OWn, /Lessee4ritractor as Agent for Owner
The forgoing
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of Notary Public -State of Florida i
Personally Known OR Produced Identification a�
Type of Identification Produced L j�_
Commission No.! =�;V �`�'�1, jSealj
Revised 0711512014
Signature of Contract6r/ense Her
The forgoing instrument was acknowledged before me
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No O, Pubiiv SiW°e a1 Fiorit ;
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(Nameofperor`,Rled,$r°
lSig atur 'of Notary Public- State of Florida j
Personally Known OR Produced Identification "
Type of Identification Produced f
Commission No. (Seam
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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