HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
i��Mzrl -AUG RECEIVED
Building Permit Application 1 0 2018
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
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Address: '9150 tAfaCta w 10 c IL LCL11-Z S-t' 1-vc,e-
Legal Description: Thi C aLt Gov6(Avic4 �I� 1. - aLIL '45 Lot y
Property Tax ID#: 3LZ5 06 ILp — OOo - (_O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work toe e orme under tispermit-checka appy:
HVAC 11 Gas Tank Gas Piping _Shutters Q W' ows/Doors
11 Electric 0 Plumbing []Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction': 21 OO S . Ft. of First Floor:
Cost of Construction:,$ 5 , �21 Z. Utilities:Sewer Septic Building Height:
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�OW.NwER{�LLS��`L�`� r
Name Debi-& I JBr ghfi Name: L/An P'�Q-r_A
Address: ISO baa.--, 6,,k IcAn-e__ Company: Tota -6n ns S vaI,
City: 5?-• Lva�e- State: I_L Address: 32 O1
Zip Code: .3`{ Fax: City: SI L.C-Y r State:..
Phone No. '1-1 12- J Zip Code: 3`1611 Fax: '11L-g�'L' °3c
E-Mail: SCAB, r 'i-a I roaf�nc,54.s W,�6-ne-t Phone No. -1-7 Z - 7 2- -803 b
Fill in fee simple Title Holder on next page(if different E-Mail: Sa wi rA G2i'I-o�'�I °d �ysySk�,s- e
from the Owner listed above) State or County License: 1uC C 1310-19-9
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SU£PPLEI�IIEN AL CONS R; C f1,01 L1, N xLA�1N ISN rOR;MA.V-1
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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 attorney before
commencing work or rgWrding your Notice of Commencement.
Signatur f Owner/Lessee/Contr or n r Owner Signat of Contractor/License d
ST TE OF FLORIDA ATE OF FLORID
COUNTY OF a��� COUNTY OF CA I
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 56""day of .(-ply 20 It' by this 3waay of—%x%!j 20,E by Nd
Name of person aking statement Name of person king statement
@r onally Known OR Produced Identification Personally Known OR Produced Identification a
ori of Identification Type of Identification a�
� n
Awa uced Produced 3 3
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Z gam' / dX0
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5 o c m d G1
a_ .E E(o ature of Notary Pub ic- a of Florida) (Sig ature of Nota ublic-State of Florida) a m w
0 eDa (i mission No. GG' J73/S- (Seal) Commission No. &G-19-73iY (Seal)
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IEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17