HomeMy WebLinkAbout1707-0533 (2) i
ALL APPLICABLE INFO MUSTIBE COMPLETED FOR APPLICATION TO BE ACCEPTED P
Date: Permit Number:,
Building Permit Application
Planning and DevelopmentSF►'*ces
Building and Code Regulation Division f� /
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fai:(772)462-1578 Commercial Residential lll»>
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the pend of line
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PROPOSED,] LOCATION _ s�
Address: I Fb2l
Legal Description: ' 4r
Property Tax ID#: =�� V 6— 7 ���U`r Lot No. (o
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Site Plan Name: Block No.
Project Name:
® Setbacks Front Back: Right-Side: Left Side:
DETAILED DESCRIPTION OF WORK ;
CONSTRUCTION IIVFORMATION:-,--
Additional
IV A itiona work to ee orme under this permit–check a appy: q
f,
HVAC _Gas Tank ❑Gas Pipin'lg V _Shutters it Windows/Doors
Electric 0 Plumbing 1:1Sprinklers E]Generator i Roof
Total Sq.Ft of Construction:; S . Ft.of First Floor:
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Cost of Construction:$ �' �� Utilities. _Sewer Septic Building Height:
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OWNER/LESSEE f CONTRACTOR _ 3
Name Will( ki !Y Name: 416 :h�f 4,11
P64 n
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Address: 5 d .4t4Company: r
City: (z%yc � State:_ Address: �f
Zip Code: 3 � y � Fax: City: I_ssf State- /
Phone No. 77.1 3Zip Coder LOF Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed ab State State or Coun Licens '
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City State:
Zip: Phone: I Zip: Phone,
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name- Name: h
Address: ' Address: d
City: City:
Zip: Phone: Zip: Phone:l
1 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 herebyAgree that i will,in all respects,perform the work
in accordance wititthe approved plans,the Florida Building Codes and St.Lude County Amend lents.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screewoomsi,Rand accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your-oaying twice for
Improvements to your prgperty.A Notice of Commencement must be recorde&and{posted on the jobsite
before the first inspection.If you intend to obtain financing,consult with lender,or an attorney before
commeming work or recording our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder-
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF lw.�
The forgoing instrument was acknowledged before me The forgoing instrument was,acknowledged before me.
this day of - -20 1 by this,day 20� by
(Name of person acknowledging) (Name of person acknowledging)
i
i a ure of Notary Public-State of Florida) (Signature of Notary Public-tike of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of identification Produced
Commission No. I (Seal) Commission No. (Seal)
J
ii HNAINGRAM
1 .•'o•Pav p`B<<;'; Notary Public-State o o LASHAHNA IN
2018 :iPly �.,
Revised 07/15 .`�y Comm.Expires Dec 20, =°a ,�allotary Public State of Florida
commission# FF 177249 .g _?_My Comm.Expires Dec 20,2018
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',EOFF� 3onded througn Na wi a - ,�
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REVIEWS ,FRONT= Z0(dING SUPERVISOR PLANS VEGETAT10lV-,S j' =R1 & 'VE
COUNTER REVIEW REVIEW REVIEW REVIEW V '� REVIEW REVIEW
DATE
COMPLETE
INITIALS
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_ Planning& Development Services
` Building&Code Regulation Division
2300 Virginia Avenue
® Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit# —co,3
�J oc4CL , licensed as a(n)Contractor*/Engineer/Architect
(Please print name&circle license type) *FS468 Building ill nspector
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*General,Building,Residential or Roofing Contractor or any individual certified under 468 F.S.to)make such an Inspection,
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On or about (0:, D 19 /%A ? i did personally inspect the roof deck nailing
(Date)
work at: �' -e'ly4 A OQ-
(.lob site address)
Based upon that examination I have determined the installation was done according to the current
editio of the Florida Existing Building Code Section 621 or the product ap"provai submitted (whichever is
most t igent).
C
gn ure and Seal License#
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STATE OF FLORIDA
COUNTY OF tt
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Sud rn to an subscribed before me this day of 20��
by t . Who is personally kno ,i to f e or who has produced
' as identification.
Notary Public,Sta to
Signature of Not ry: Seal
Commission Num .,
En 01J19J2011 LASHANNA INCRAM
'�� � tiotary Public State of Fiorlca
"•,. lr2y comm.Expires Dec 20,2018.,
commission f#FF 177249
banded through National Notary Assn,
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