HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L' -1 Permit Number: 0 h ®Lri 3
• FFEB
IVED
Building Permit Application4 2019Planning andDevelopment ServicesBuilding and Code Regulation Division ty, Permitting
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
PROPOSED IMPROVEMENT LOCATIO'W
-7 '9 4� w � �L —�'b">
Address: _ >
Legal Description: b.: qkc S 'FQ•� �'�a Q� �QVQ,r1l1GQ C il
Property Tax ID#: ?N0ku- - -o1- nZ Sa- 0-0b - 4 Lot No.
Site Plan Name: Block No. $
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: n"..
ink Z60_� CA Y1 in540'l( new jV'VN \Qs
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a appy:
HVAC E]Gas Tank []Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator 0 Roof S � Roof pitch
Total Sq. Ft of Construction: �.65� S . Ft.of First Floor:
Cost of Construction:$ Cl CD� a Utilities:I Sewer 0Septic Building Height:
OWNERAESSEE CONTRACTOR:
Name \C _CLr GAS Name: ' 010/x, (1Q
Address: Lt-1 V.1V� Q. 1 vJ Company: TREASURE COAST ROOFING
City: or LQdo. State: Address: 1816 SW BILTMORE STREET
Zip Code:__�A°I S�• Fax: State:FL
Phone No. iLko " 3s6Q) Zip Code: 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: TCROOFINGLLC@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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable pp cable 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:1816 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 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.
Signature of Owne Lessee ntractor as Agent for Owner Signatur ontract r cense der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF STLCUIE COUNTY OF STLUCIE
The for oing instrumewas acknowledged efore me The for oing instrume w s acknowledged before me
this f day of d 201 by this�day of 20_ 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
(Signature of Notary Public-State Florida) (Signature of Notary Public-State of rida)
Commission No. d 2 (Seal) ion N ?Y2 �r ealilotary Public da
victor G Alterizio
Notary Public State o Floridan c My Commission GG 2 4 2
or G Alterizio ' Expires 1110512022
'�� . My Commission
REVIEWS FRONT Z IIS ti �R�Ef� 224RPVA1EKW1
VEGETATION SEA TURTLE MANGROVE
COUNTER R REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17