HomeMy WebLinkAboutRoof Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'0 I(-� Permit Number:
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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 1�
PERMITTYPE: �E_ R S4-hr,)(,t.C—
PROPOSED IMPROVEMENT LOCATION: _ �—
Address:
Property Tax ID#: Z`� (� C3--0(:)OS noJ -_Gf Lot No.
Site Plan Name: p Block No. 0 —
Project Name: (�' Z N 33' �
DETAILED DESCRIPTION OF WORK:
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------------------- --- ---------- ----
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator I/Roof S I/ 2- Pitch
Total Sq. Ft of Construction: Sq. Ft. of F►wi r: La cy-t+-
Cost of Construction: $ 00. Op Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name /�X1Cl (( L 1 L, Name: " u '�:-. 1� � r-�� ez-
Address: LOB-43 NW Sa'T'` St- • Company: J'VUArc
City: Doml State`' Address: s301 f\-� f
� ", il, �- /�CL(Q
Zip Code: 3«& Fax:L2&)36,o- 6045 City: ►�r i rc4 q State: -F;11 =
Phone No. (395 81's-C12/cp Zip Code: 3.r,I Fax:
E-Mail: Phone No305
Fill in fee simple Title Holder on next page(if different E-Mail Yn.CAQ2&-- t O-ef►-f4S 6? yahoo,C �
from the Owner listed above) State or County License �.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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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 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 Commenceme
Signature ner/Lessee/Contractor as Agent for Owner Signa u of Cghkractor/Licen Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF `�x &� COUNTY OF _ c +t,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of —'P7t 20 I`l by this `�day of c 20 n by
-LCeGTd vt_ C.A n c vs Q �o -A ieaa soic
Name of person making statement. Name of person makin statem nt.
Personally Known ,V OR Produced Identification Personally Known 1-0� OR Produced Identification
Type of Identification Type of Identification
Produced Pro du d
ANA KA RINA PEREIR,
(Signa ure of Notary Pu I,iAft�cF� is State of Florida ( ature of Notary Publi q� �Iorl
mission rr GG 279639
Commission x GG 279639 ''� vtti��` My Comm.expires Nov 26,2022
Commission No Z My Con(Me&Pires Nov 26,2022 Commission No. a 3� Bonded tqf egW}ational Notary Assn.
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.