HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE
EEyCOMPLETED FOR APPLICATION TO BE ACCEPTED r�
Date: �� • ! Permit Number: / V S7_C37617
• RECEIVED
Building Permit Application
Planning and Development Services MAY 1 6 2017
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 5��1L ��i1e \,�ri� �Y� i e[ce . H� ?SL1gg2
Legal Description:7wo c ,at, Z%%arY ib�Q_kcs- UYi+N Di- C6L\L te; - LL^�I-A
Property Tax ID#:'&1102-C O!;- Lot No. 3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
"C.r cq 51 MEN,,. roo� �andtar%%An.,t n k,"\ace `N�vkd 3\ywdo d,wncx�\ decK.�ncd �o tea.
u oda\1 vv" vOt 25 V%*ncJ w,c�4,r1c►yrrn.,�, �hb\4\\ 'T��nnk o � x;�C.Be a1n;�►�g��
=CONSTRUCTION INFORMATION:
Additional work to be ertormed under tispermit-check all tha appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
1-1 Electric Plumbing Sprinklers 1:1 Generator Roof ® Roof pitch
Total Sq. Ft of Construction: 1,532 SFt.of First Floor: 1,5-42
Cost of Construction:$S FTiol7� Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name i LC Name: T �+ ,�� V , CZ11,e_4:J:j
Address:�zAm s\!,n)'r ocu Company: L=%, y"J'n4ers T1�;e��Cl.i�L
City:1�06 _, ►fr c i State: Address: Lg J Q J 'Q k)660 nan ��l L
Zip Code: 2L9'R2- Fax: City:}-�rA Rkd ee State:-E—L
Phone No. 2�l-?,�L�'� Zip Code: 3�-l�}� Fax:���-21a�1-U3�g
E-Mai1: Gseu 6'�In,(kr1�,�� -c , r,gym Phone No. 2- 33 2- 'R q'&-D
Fill in fee simple Title Holder on next page(if different E-Mail: ri C kCA-3l{� Oo LC :Ua�
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable 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 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 to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_5C ,,n_(1,%C!e_ COUNTYOF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_)5-day of )MOM 20 Eby this °�day of 20 J'by
ems;
(Name of person acknowledging) (Name of person acknowledging)
Q&IL' 2Z&6 '
(Sign re of Not ry Public-State of Florida) (Sigrtafure of Nota Public-State of Florida)
Personally Known_X OR Produced Identification Personally Known- X OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. SALLY PORTES o mission No. (Seal)
�O�►•r ry✓QD.
••° Commission N GG 476 5
• "" "�� SALLY PORT
---mission Elp"
ES
OU 47UZO
November 15, 2020 0•W-4
°`�- Commission 4
Revised 07/15/2014 y4j' ""�� z• :s My Commission Expires
November 15, 2020
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