HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFQ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: � 1 ,1 1 I Permit Number:
-1 71 RECEIVED
Building Permit Application JAN 17 2018
Planning and Development Services
ST. Lucie County, PmMfllttltlp
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: -,Q_ -2:00
PROPOSED IMPROVEMENT LOCATION:
Address:-0 3ChQ V1 1� -, Re 3`4 O(Td-
Legal Description: INDIAN RIVER ESTATES-UNIT 1-BLK6 S 33 FT OF LOT 16 AND ALL LOT 17(OR 1232-2849)
Property Tax ID#: 3402-602-0208-000-9 Lot No.16 and 17
Site Plan Name: INDIAN RIVER ESTATES-UNIT 1 Block No. 6
Project Name: Luster Residence
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Tear off existing roof, install new underlayment and accessory metals, install new shingles.
CONSTRUCTION INFORMATION:
Additional work to be Dertormed under t ispermit-check all apply:
HVAC Gas Tank E]Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof 5/12 Roof pitch
Total Sq. Ft of Construction: 3400 S . Ft. of First Floor:
Cost of Construction: $ 9.000.00 Utilities:]Sewer Septic Building Height: 12"
OWNER/LESSEE: CONTRACTOR:
NameDo �o\ O n f, Name: lu an Q� 1
Address:_5 A 3 '6 ychana-n �D'2 Company: Total Roofing Systems Specialist
City: 1--aA �tV_C,2 State:F� Address:3,)-0A fJE DOnnAv 'C4GL �tf.
Zip Code: 34982 Fax:772-872-8033 City: S+0 o'e:� State:FL
Phone No.772-872-8030 Zip Code: 34997 Fax: 772-872-8033
E-Mail:gleiza@totalroofingsystems.net Phone No. 772-872-8033
Fill in fee simple Title Holder on next page( if different E-Mail: gleiza@totalroofingsystems.net
from the Owner listed above) State or County License: CCC1330788
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: j
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 the permit 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 rec9rding your Notice of Commencement.
Signature caner/Lessee/Contr ge t fo ner Si ure of Contractor/Lir old
STATE OF FLORI STATE OF FL RID
COUNTY OF COUNTY tot
The fgr_gping in rument was acknowledge before me Th f�, ongoing instrument was a I<nowledg�before me
this ay of 20�� by this day of 20 by
___Sy.eJyP►Ca�. .�2 �u
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
SL
(Signature of Notary u lic-State of Florida ) (Signature of Notary c S Florida
' r
° . M �3 NNIE LOVIT
Commission No. ;;v`'�'•"•�;: Q�II)IIE LOVITT Commission No.
'c MY COMMISSION#GG14343e MISSION#GG14 C,
EXPIRES Se ��?Fi.,. EXPIRES September 17, 0
September 17,2021 I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17