HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 • �.�• IT Permit Number:
RECEIVED
Building Permit Application
MAR 2 6 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, 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]MPROVEMENT LOCATION:
Address: QLG �C�- 1 6� C! I,
Legal Description: VGe,Ws r-LAnenA at _�.ucLYt o, C'Jub �171t�►5� c�.
Property Tax ID#: "Ag�.�'—7 as " D Lq3— 006 v O Lot No. d41
Site Plan Name: Block No. too
Project Name:
Setbacks Front Back: Right Side: Left Side:
.DETAILED DES/CC R`IPTION,OF WORK: L
F'60, OT �u��5��!!�c r26d. tx d 1'n jrT!2 hGH/
CO'NSTRUCTIO'N INFORMATION:
Additional work toe performed under this permit—check a appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
0 Electric 0 Plumbing Sprinklers 0 Generator H Roof Roof pitch
Total Sq. Ft of Construction: 3 aos� Sq. Ft.of First Floor:
Cost of Construction:$ 11, 1304) Utilities:SewerEl Septic Building Height:
OWNER/LESSEE: . CONTRACTOR:
Name Avi A lzName:
Address: _ka t rig \.)SCompany: TREASURE COAST RO FING
City:e7)04 4. 1,V �`' State:_L4 Address: 181`6 SW BILTMORE STREET
Zip Code: A(4 qSa Fax: City:�l7`�'C ��. 'JC1�- State:FL
Phone No. �� q�— 360 7 Zip Code: 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 IRFO;RMATION:: ..
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 of Commencement.
Signa a of Owner/L e Contr c as Agent for Owner Signature o Contractor/L' nse Ho er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF STLCUIE COUNTY OF STLUCIE
The forgoing instrumerit was acknowledged before me The for oing instrume t was acknowledged before me
this,( day of /cti 20LJ by this day of lftgtffA 20-4 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
4�A /ff aa=gj�� a�4 ."H
(Signature of Notary Public-Stat of Florida) (Signature of Notary Public-State of FI ida)
Commission No. .2 Qi (Seal) Commission No. 2 (Seal)
°W Notary Public State o Plodda
victor enzio 4V Pty Notary ublic tate o on
REVIEWS FRONT Z � f 0=W N VEGETATION TT�Iftor
COUNTER R "` REVIEW W__ Co � 62
Expires 11/t��W
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17