HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: `
_ _ .�... .__.._�. REC
AU G �.2013
Building Permit Application Permitting_
Planning and Development Services ST. Lucie County,
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:51003 �SUn ,�J
- blyd
Legal Description: 11h6on K,wer CSc 4niex-ond- 0$ -INY_ 5$ LID\- 3$ (00 3W IWO
(Q(' 31y230 1 ► 3$o3�� j
—,,.�q38 ) ��!!--
Property Tax ID#: 3402--Wi-6��2DOW/1 Lot No.
Site Plan Name: Block No. S-1? —
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1. 39
CONSTRUCTION INFORMATION:
Additional work tobanerformed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof 4.12 Roof pitch
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ IC Utilities:[]Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name conrcia o3he'fc Name: Swf
Address: $ %('U) A111C4 Company: SDt" CW�Qfthlloi 40A 40ah S
City: State:fL Address: 3]140 E. Cebla u
Zip Code: Fax: City: (4JP,lilPllGe State:
Phone No. _,1,"1 103-I ,,1,4Zip Code:32-132- Fax:
E-Mail: Cori`m V�SW q . (le-k- Phone No. L)01-S2c/ M-1
Fill in fee simple Title Holder on next page(if different E-Mail:%, a(le4f, M seroUA-�. i o
from the Owner listed above) State or County License: CCC 13 1 rho 5q
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION-
DESIGNER/ENGINEER: Not Applicable ,,mowrTAGE COMPANY: _Not Appl' ble
Name: Name:
Address: Address:
City: e: City: State:
Zip: Phone Zip: P e:
FEE SIMPLE TITLE HOLD _Not Applicable BONDIN OMPANY: _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
commencWg work or recording our Notice of Commencement.
Signature of Owner Lesse ontractor as gen or O er Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF >t, loU>✓ COUNTY OF S�-- WCle
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this j day of RVOiU* .20J_& by this_d_day of 20-gL by
Name of per%gprmaking statement Name of erso aking statement
PersonallyKnown OR Produced Identification Personally Know OR Produced Identification
y
Type of Identifica 'on Type of Identi tcatio
Produced Produced
hUkA, 4&11�r_
(Signature o ota -tqj ,eStatV F (Signature of taryP
•, o ery ublic tete o{Florida �V0 Notary Public tate of Florida
Kelley C
Commission No. yComm�k;G 240879 Commission No. Kelley
q Expires 07/27/2022 My Commission GG 240879
p Expires 07/22/2022
A PON
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17