HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: AuskOo
.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 CommL-rcial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED I'MPROVEM`ENT"LOCATION
Address: oaf 41 ` s-0-Al S Mk_sk-
Legal Description: 0.9,14's 1,0A AO& SQ%.)A^A0. C,�Ua ��R r a.
Property Tax ID#: 3 4ANQ zyjS- W)6 0 Lot No. ;
Site Plan Name: Block No. C!
Project.Name:
Setbacks Front Back: Right Side: Left Side:
DETAILER.DESCRIPTION OF WORK:'
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� Y'OQ�• Q.,r, �t'1S`b Q� r�.�/ 5�,�''2S�s ari tl .
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit—check all apply:
HVAC L_I Gas Tank Gas Piping _Shutters Windows Doors
❑ p g . ❑ /
Electric'
Plumbing Sprinklers Generator ®Roof Roof pitch
Total Sq. Ft of Construction: L644 Scl.Ft.of First Floor:
Oo
Cost of Construction:$ J a: Jr� d Utilities: _Sewer❑Septic Building Height:
OW'N ERAESSEE: CONTRACTOR:
Name Name: ,Q
Address: o)Rq I �Ge.l� I�QS'� way Company: TREASURE COAST ROOFING .
City: !p n Sst• Lu c.:,a. State:,_EL- Address: 1816 SW BILTMORE STREET
Zip Code: e1- Fax: ,City: v s>V- Ca,L- State:FL
Phone No. Zip CO)e: 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: TCRO.OFINGLLC@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..
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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:1818 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 Counter 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
commencin 'work or recording our Notice of Commencement.
Signa ure of Owner/, ssee/ ntractor as Agent for Owner' Sign4tu rkTtontractor/ ' ens er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST LcuIE COUNTY OF sTLuciE
The for oing instrumept as acknowledged before me The for oing instrum nt was acknowledged before me
this day of 20Z by this day of b 26X by
BRIAN J MALONEY BRIAN J MALONEY
Name of person making statement Name of person making statement
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
/.y tl,,"I' ,.&
(Signature of Notary Public-Stat of Florida) (Signature of Notary Public-Stat f Florida)
Commission No. ,2 (Seal) C n No.64-
4//,Z 92— (Seal)
Notary yRoor G Alt rtzi0 of Florida
My Commi 0 1 0 2 d►rLw Public Stte of
on
REVIEWS FRONT ZO �21
S�'f f S� VEGETATION r ?i �QB2
COUNTER REV REVIEW REVIEW .s 1 s
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17