HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLELINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4-�.i W Permit Number: 1 c1 OW 0 a<a
COUNTY'D A • 4/3p ,f)
F .. 0 R I
Building Permit Application . 0
Planning and Development Services s.<o09oe I4
Building and Code Regulation Division 0c�°d
2300 Virginia Avenue,Fort Pierce FL 34982 0‹/2,..-,),
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 LOCATION`-- ` - -
Address: 1-16C7-0 a W o(jd 'tor,
Legal Description: A1 ( OL ? NCS lj l b r 101511 I Lt
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Property Tax ID U: J S13— S 0a.- C)Z X"f- 0 l7 b -3 Lot No. qa-
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit—check all apply:
HVAC I1 Gas Tank nGas Piping _Shutters n Windows/Doors
0Electric 0 Plumbing 0Sprinklers Generator ® Roof Mil Roof pitch
Total Sq. Ft of Construction: 300 • Sq. Ft.of First Floor:
Cost of Construction:$ 1)� D Utilities: _Sewer ElSeptic Building Height:
OWNER/LESSEE: I� CONTRACTOR: •
Name "DAu; a A. L2hov tliet Name: Par j c,n Hct k ri
Address: 96-0,Z1 9.2 c3�.►odCil 0r. Company: TREASURE COAST ROOFING
City: 1=04 •—pi L e Ce State: FL Address: 1816 SW BILTMORE STREET
Zip Code: 345 &1 Fax: City: 5,(4. s.L, cm// State:FL
Phone No. (y c7'? 3o t $ 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: 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
osted on the jobsite
p
before the first inspection. If you intend to obtain financing,
consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
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Signature of Owner/Lessee/Contr r as Agent for Owner Signature o'"ontractor/L' e Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST LCUIE COUNTY OF ST LUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Z day of April ,20 /f by this Z day of Ape;/ ,20 if by
BRIAN J MALONEY BRIAN J MALONEY
Name of persoriTerArimi Name of person making statement
Personally Known x AiVelpiluceiaSir{ aji6OHEAD Personally Known X OR Produced Identification
Type of Identification f;,, Notary Public-State o�o da Type of Identification
Produced ;�.,i,A� Commission#GG 311365 Produced
ij+.„ o;r` My Commission Expires
'',,1,,'" March 13, 2023
-A� ------1116/"...1
.r JOSHUA REDHEAD
YPV��
_�'°� °��-Notary Public-State 3f •lorida
Signature of Notary Public-State of Florida) (Signature of Notary Public-State €n,;-.,.:�
Commission n GG 3 1365
°off'FF4 My Commission Exvires
�� u��" March 13, 2C2,
Commission No. �'(f. ,3//36$ (Seal) Commission No. (f('-3S
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED 1
DATE
COMPLETED j
Rev.8/2/17 j