HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �`-1
Date: a` 35 \ I� Permit Number: �� -a,, �1 1
RECEIVED
Building Permit Application FEB 2 5 2099
Planning and bevelopment Services ST. Lucie Codrit PeFftilfllfl9
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 linep��,
PROPOSED-IM'PROVEMENTLOCATION': -_
Address: Q A
Legal Description: `j�. LU6 Q 92"in5 aq a 6 qQ 2t,k a 5 3U W
OT t) qqs P ®-(, Lo4 to
Property Tax ID#:� 1610 -300- 1 Lot No. ID `
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
n51c. nlLw
CONSTRUCTION INFORMATION:
Additional work toe e orme under t -checkispermit a appy:
HVAC Ei Gas Tank Gas Piping _Shutters Q Windows/,Doors
11 Electric 0 Plumbing Sprinklers Generator ®Roof I`T"� Roof pitch
Total Sq. Ft of Construction: 44956 S Ft.of First Floor:
Cost of Construction:$ f T, r7 CT Utilities:ElSewer El Septic Building Height:
OWNER/LESSEE:, CONTRACTOR:
Name MiCA 1�,Cl&Iws i Name: ' Q n,
Address: -7 of Company: TREASURE COAST ROOFING
City:�D'OY4 Sl_ L jc-)!-P- State: FG Address: 1816 SW BILTMORE STREET
Zip Ccde:'14354 Fax: c� City: ,r Q State:FL
Phone No._- 17� " 3 3,3- P���! 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 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:1616 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 pf Commencement.
Signature of Owner/Less Contract s Agent for Owner Signa'fuContractor/Lice Hold
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST LCUIE COUNTY OF STLUCIE
The forgoing instrume t was acknowledged before me The forgoing instrument as acknowledgeAbefore me
this day of 20K by this 2rday 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
4a- X �&� Z
(Signature of Notary Public-St of Florida) ignature of Notary
Public-State f Florida)
Commission No4� 7 d4ei (Seal) mmission No.L�'U'.27Z/25Z (Seal)
r.el'v.
Notary Public State of Florida
tctor G Altenzio 292 P46. NotaryPublic State of Florida
c. • a 1110512022 Victor enz
io
REVIEWS FRONT Alllhlti NS VEGETATION T �re 1�I�OVE2
COUNTER REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17