HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�. c
0
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRO:POS'ED IMPROVEMENT LOCATION:"
Address: 56 SAN LUIS OBISPO, FORT PIERCE FLORIDA
i
Legal Description:
Property Tax ID#: I �I - I1 I— 0001 ' 00Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
OETA1LED DESCRIPTION,OF WORK „
REMOVE AND REPLACE SHINGLE ROOF
I 'CONSTRUCTIO"N"INFORMATION7_71
Additional work to be nartormed under tispermit-check all that appy:
HVAC , Gas Tank E]Gas Piping Shutters ❑Windows/Doors
Electric ❑ Plumbing ❑Sprinklers Generator Roof 3: 2 Roof pitch
Total Sq.Ft of Construction: 1440 SQ. Ft.of First Floor:
Cost of Construction:$ 4975 Utilities:0Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameROBBI,N DAVIS Name: EDWARD LECHNER
Address:56 SAN LUIS OBISPO Company: EDIFICIUM CONSTRUCTION LLC
City: FORT PIERCE State:FL Address: 1215 CASTAWAY BLVD
Zip Code: Fax: City: VERO BEACH State:FL
Phone No. Zip Code: 32963 Fax:
E-Mail: Phone No. 772 643-4513
Fill in fee simple Title Holder on next page(if different E-Mail: EDIFICIUMROOFING@GMAIL.COM
from the Owner listed above) State or County License: CCC1331308
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:1215 CASTAWAY BLVD 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 an attorney before
commencing work or fecording your Notice of Commencement.
Signature of Owner/L /Contractor as Agent for Owner Signature of Cont ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing'instrunt as acknowledged before me The omg instr en was acknowledged before me
this'aaday of 204 by thi day of 20& by
ZAJ!LLC"�' N <� A UiLa/%d &so��
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identific,�n
Produced TL. c�* Produced `d-L-
(Signature of Notary Public-State of Florida) (Sign ure of Notary Public-State Florida)
Commission No. Commission No. __(Seal)
LASHAHNA INGRAM
Ina us �„ „ LAStifh^.A IId�RAM
Notary Public-State of Florida `2o��0.Y ��; Notary Public-State of Florida
0 2018
"^9 ��`� Commission %FF 17%249 N+ ti,�Fa.jssi n#FF 177249REVIEWS !Flf'Ol�[A0,, o r LFA Natio ia�IYtaP��isVISOR PLANS VEGETAT'r 0uq Nk�tk/AING�QACOUNTER-E;-,='REdVTW�` --�-RE� tEW REVIEW REVIEW R
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17