HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
k Not Applicable
Address:
STATE OF FLORIDA / �(� Ccc
t
Address:
COUNTY OF
City:
Zip: Phone:
State:
City: State:
Zip; Phone
FEE SIMPLE TITLE HOLDER:
Name:
_)S_ Not Applicable
BONDING COMPANY:
Name:
oZNot Applicable
Address:
Personally Known OR Produced Identification
Address:
Type of Identification
City:
Produced
City:
((Signa ure of Notary Public- State of Florid
Zip: Phone:
_..i......I H i -inn x inriirAtpri.
Zip: Phone:
_
OWNER/ CONTRACTOR AFFID : Application is hereby macie
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 ssocpeion rmit will authorize the permit holder to build the subject structure
which is in structure. Pleaws or an
secconisult with pyour Hlome Owners Association tandr reviewyourdeed or any restrictions nts that wh ch may arestrict or . prohibit such
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
WARN44G 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
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commencing work or record ingyour Notice U l,vi i n Iici I%_C
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Signature of Contractor/License Holder
Signature of Owner essee/Contractor as Agent for Owner
STATE OF FLORID
STATE OF FLORIDA / �(� Ccc
t
COUNTY OF-
COUNTY OF
The for oing instrument was acknowledge(pefore me
The forgoing instrument was acknowledged _l�ebfore me
�%/ day of by
t�/
this _ day of 201t by
this _, __V
/
ic. 44 L.� � 6 111Z( !'1l)3 �liRP—)
/
�O�J .G l S S ten. ,k vim-)
Name of person making statement
Personally Known x OR Produced Identification
Name of person making statement
k
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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((Signa ure of Notary Public- State of Florid
(Signat re of Notary Public State of Flor' )
oY Ful MARK KENNY
° I)
�c+ pU� MARK KE
Commission Nord 41)
Commission uuaission#GGt
on#GG1444���PP
N e Ewes September 19, 2021
€ o` Expires September 19, 2021
9TF oc F0 Bonded Rn Budget Notary Services
Bonded rtwu Budget Notary =
REVIEWS FRONT
ZONING SUPERVISOR PLANS VEGETATION
SEA TURTLE MANGROVE
REVIEW
COUNTER
REVIEW REVIEW REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .S b Permit Number:
Willow Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential X
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: b a- 'z'
Legal Description: W3 \ J
Property Tax ID #: 3yti�. �nu� � I S3 � DUU - ��
Lot No.
Block No.
Site Plan Name: M
_
Project Name: �-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�¢. - t o n �- �' 2��-•l u � A. Ly�>I >>r-:,�� , ,r, �1-t � - re. �J
1 �• Cly, w l��-• �'1 � r�S�.l..g
"*A t o uA .
CONSTRUCTION INFORMATION:
Additional wor to e er orme un er t is permit - c ec a app y:
Gas Piping Shutters
❑_
Windows/Doors
HVAC Gas Tank _
❑ Ei
F X] Roof Roof pitch
Electric ❑ Plumbing Sprinklers Generator
Total Sq. Ft of Construction: ,I -Sal - S . Ft. of First Floor: i.J
ESeptic
/ 2a
Building Height:_
Cost of Construction: $ 9 u0 V' U U Utilities:CnSewer
OWNER/LESSEE:
Name
Address: t-1°IU,.
City: C�-•�State:
� �{ C;
Zip Code3y°1�a► Fax: wi ii
Phone No.
E -Mail: ;-/ / A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: Ca1'Jt'Y%-
Company:
Add remi�ss:
CitState: 1
Zip Code: �JLi��a Fax: YJ ) 1A
Phone No. uS� - l
E -Mail:` L» tx^,C1`,n�
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.