HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED LDate: Permit Number: V J
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• RECEIVED
Building Permit Application AUG 08 2017
Planning and Development Services Permitting Department
Building and Code Regulation Division SX:County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lined-�
PROPOSED IMPROVEMENT LOCATION:
_ 11/
Address: y SCS &Z>5 &C, 05
Legal Description:. Dc"I � 5h e<S 2
Property Tax ID#: >q d - 5d/ - `7 a I — O0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
e.)C1S'GI'( 5 k06� arYd
a.'-C� JC' b St`s
CONSTRUCTION INFORMATION:
Additional work toa rformed under this permit-check all that apply:
HVAC Gas Tank Gas Piping 11 Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers 1:1Generator F'l Roof Roof pitch
Total Sq. Ft of Construction: 1-7 CCS Sq. Ft.of First Floor: n
Cost of Construction: $ Ci 750 Utilities:11 Sewer ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Pcz4 G Name: r i Cw% Nat
oou y
Address: 5 1,->5 {4 S Company: TREASURE COAST RO FING
City: pod 61, (<jc i t, State: d`C. Address: 1816 SW BILTMORE STREET
Zip Code: 31J(36_a Fax: City: Dbr'� �k 6Vc�j-Q State:FL
Phone No. '7 7 6 3y "YOq Zip Code: 34984 Fax: 772-343-8358
E-Mail: Phone No. 772-370-9770
Fill in fee simple Title Holder on next page( if different E-Mail: TCROOFINGLLC@GMAIL.COM
from the Owner listed above) State or County License: CCC1330653
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: 1816 SW BILTMORE STREET 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 recording our Notice of Commencement.
Signature of Owner/ s e/C r for as Agent for Owner Signature of Contractor/Li a Hold
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF STLCUIE COUNTY OF STLUCIE
The fWoing instru ent was knowledge¢pefore me The f oing instrum t was knowledged before me
this� day of 20 Y�by this T day of 20JJ by
BRIAN J MALONEY BRIAN J MALONEY
Name of person n tatement Name of person making statement
Personally Known x roduced Identification Personally Known x 11�7 roduced Identification
Type of Identificatio Type of Identificatio
Produced Produced 7.1
<�Vlli�
(Signature o10.
to ublic-State of Florida ) (Signature otary Pub
ROBERTBRUNKE
CommissionFF122434 Commission NO. FF122434 t+�I:` '; NotaryIgy$lyteofFlonda
R BERT BRUNKE ' Commission#GG 176972
Notary Public—State of Florida -`a M Comm.Expires May 12,2022
Commission#GG 176972 Y y
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REVIEWS FRONT PLANS VEGETATION SEA TURTLE MANGROVE
COUNTE REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17