HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INF,O1 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �y
Date: �� `� Permit Number:
RECEIVED
M0.0 IR
Building Permit Application
AUG 16 7.018
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: To Select from dropbox, click arrow at the end of line
PROPOSEDIM. ROVEMENT LOCATION. -
Address: QM6r U)4
Legal Description: 664 Ie Q -0
wr X32 CoQ 3&5=y1&) 2
Property Tax ID#:. O/S/-Ctn - Lot No. c�7
Site,Plan Name: �Z(�7i Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION%OF WORK. ;
e-2 $ Uarres h� l� LnS er�il L 1,0107�/-
CONSTRUCTION INFORIVIATfO:N
Additional work to be performed under tispermit-check all appy.
HVAC Gas Tank E]Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers E Generator Roof Roof pitch
Total Sq. Ft of Construction: X7"�2—? eO Sq. Ft.of First Floor:
L
Cost of Construction:$ '6 Utilities: Sewer 0Septic Building Height:
O.V1/NER%LESSEE CONTRACTOR:' .
Name Name: Christopher Dutruch
Address: 22 e Company: MAC MAR, LLC/My Affordable Roof
City: ''PSL State:jt—� Address: 1585 Kennesaw Drive
Zip Code: ?)L/QcS Fax: City: Clermont State:FL
Phone No. U " �2 U! Zip Code: 34711 Fax: 772-905-8694
E-Mail: Phone No. 772-206-3344
Fill in feesimple Title Holder on next page(if different E-Mail: wendell@myaffordableroof.com
from the Owner listed above) State or County License: CCC#1331305
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-SUPPLEMENTAL CONSTRUCTION LIENLAW.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: 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.
Signatu of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAJ STATE OF FLORIDA
COUNTY OF �Cf(`�C(/'�j COUNTY OF yar
The for Mng instru ent was cknowledged before me The f ing instru ent was cknowledged before me
this r day of 20_ by this day of �1 viS f 20_1e by
Name of per on g statement Name of pers making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signatur o g °���rljlic-S{ BIf J&ia0l)TTAIN (Signatur f �t r�-' biic St t bf Flo ida�)
Notary Public-State of Florida �.��a�P��,,, THOMASINA I.BRITTAIN
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'•; : Commission# 819 ° +`c's Notary Public-State of ����
Commission a Commis n o
Expires Jun 16,2019 ; + . n#FF 240 19
Bonded through National Notary Assn. My Comm.Expires Jun 16,2019
Bonded through National Not Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17