HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1�� \5��1 Permit Number: n va-d� �a
W71R
Building Permit Application DEC 1 5 1011
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 By
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ResidentialY
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
H
Address: r rni n� Q.Q�I , C� �Cc i, "c
Legal Description:��r�i�Yl (: kP S �� �� rn; r,� Tz'Pr'i I
Property Tax ID#: --41 y - ' LSQ ' 1-9 Q I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�,n�er\Gyrne�� FL ICc�4�-� rt nJ�c.\\ -T-ArnK.v af 6-,:-kc,+JCCO S'kinCJ►�p
CONSTRUCTION INFORMATION:
Additional work toe er orme under nd—er this permit-c ec a app y:
HVAC Gas Tank F]Gas Piping _Shutters Windows/Doors
Electric ElPlumbing Sprinklers Generator F\71
Roof L �Z Roof pitch
Total Sq. Ft of Construction: 1 S Ft. of First Floor:
Cost of Construction: $ (per SSO Utilities:0 Sewer O Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Names l�,n ;mhc:ry-1 Name:
Address: _4\ �.1 C['.m;r)c� aen l Company: L � (?,�S4erS Q,�Z Tm�irS
City: 17 r� Sc,"N r.N State: FL Address: CnIC-)1 2&L1fCr)nr)
Zip Code: Fax: City: BI�ri tP Z,rCP_ State:-h-(-
Phone No. Zip Code: 3y9 82 Fax:�-42.-2(oH-033%
E-Mail: Phone No. T42- '332- Slicso
Fill in fee simple Title Holder on next page(if differenlorn E-Mail: r� chi,,Co\�f_" c3 Qorrna�J�
from the Owner listed above) State or County License: C CCI33(78�L(o
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:
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 you intend to obtain financing, consult with lender or an attorney before
commencing work orjecordipg your Notice of Commencement.
Ulf"nature of Owner/Lessee/ ontractor as Agent for Owner Signature o Contractor/License Holder
STATE OF FLORI } (Q C. R_ COUNTY OF STATE OF FLORIDA
COUNTY OF c
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this—� \ day of CQm 20J} by this_ILA_day ofV1?f/� ,20 by
Name of person m g statement Name of person making statement
Personally Known OR Produced Identification_ Personally Known_ 4 OR Produced Identification
Type of Identifigtign Type of Identification
Produced Produced
A)—a Ltt_j a2AL/)
(Signature,of Notary Public-State of Florida) (Signature PAotary Public-State of Florida)
Commission No. C g LLY PORTES mmission No. Seal
commission N GG 47625 �':"':"' SALLY PORTES
My commission Expires _ Commission N GG 4762
�,, a���,••' Nov m 8 !�`�,c My Commission Expir s
REVIEWS FRONT I OR PLANS VEGETATION � ' o e Rt) 2
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW KLV]tVV
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17