HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
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: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: LTT3
Legal Description:
Property Tax ID #: jy0� V >J� Obi LC>l7- Lot No. l
Block No. A4_
Site Plan Name: ��V.Y1X�
Project Name:
Setbacks Front — Back: —" Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
G.�n
CONSTRUCTION INFORMATION:
Additionalwtmu1: iet mo f], epp y:
❑Gas Shutters ❑ Windows/Doors
❑HVAC Gas Tank Piping _
® Roof
❑ Electric ❑ Plumbing ❑ Sprinklers Generator Roof pitch
Total Sq. Ft of Construction:`S Ft. of First Floor:
Utilities:�Sewer0Septic Building Height:
Cost of Construction: $ IJr OOU • O O 1
OWNER/LESSEE:
Name Q G`
Address: SQD'- �_"va_�__
City: - �l tLt r _o State: .
Zip Code:39 �1 �Sa. Fax: tJ
Phone No.
E -Mail: rl 1 W
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
L.VIV 1 Rnol. I vl�.
Name
Company: --'
Add ss: �? S,S C7 SC k_c u a.1 -
City?o�A State: )
Zip Code: -! qJ� cit Fax: /�)
Phone No. a- a c)Q�' 1
E -Mail: I 2
State or County License: Qz )---IN -Au_?d IC-)
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:
State:
City: State:
City:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: y. 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
tirules,rict or plhibit such
whch
which is in conflict withapplicable restrictions may apy.
urHome Owners Assoctionandreew your deed or any
structure. Please consult any
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
Building Codes and St. Lucie County Amendments.
in accordance with the approved plans, the Florida
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
fences, walls, signs, screen rooms and accessory uses to another non-residential use
accessory structures, swimming pools,
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
must be recorded and posted on the jobsite
improvements to your property. A Notice of Commencement
inspection. If intend to obtain financing, consult with lender or an attorney before
before the first you
work or recordin our Notice of Commencement.
commencing
Sign ure of Owner/ Lessee/Contractor as Agent for Owner Sign ture of Contractor License o der
STATE OF FLORIDA c/l STATE OF FLORIDA(r
COUNTY OF 9 v r C� COUNTY OF J� z/e" G'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledge efore me
this (o day of 20! by
this % day of `1 Jam-/ '2019 by
fTi✓r��
e"13
s-1 ` 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
(Signat rgpf Notary Public- State of Florida) (Signat re of Notary Public- State of Florida )
trg u� MARK KENNY
_� Commission#GG 144499 (Seal) Commi4�rna MARK KENNY (Se )
mmtsston EGG (44499
Comrtai °' fires Se temper 19, 2021
# 021
yJF Expires Septemt�er 19�Yy�
pF F�o� Bonded TNu Budget Notary Services _ �o�
VEGETATION EVIEWS REVIEW LE MANGROVE
EA
REVIEWS SUPERVISOR PLANS
REVIEW
COUONT N ER RONING EVIEW REVIEWREVI W
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17